Provider Demographics
NPI:1932254778
Name:RUSSELL N OSNES OD & ASSOCIATES PA
Entity Type:Organization
Organization Name:RUSSELL N OSNES OD & ASSOCIATES PA
Other - Org Name:ROSEMOUNT EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:OSNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-423-3300
Mailing Address - Street 1:15083 CRESTONE AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4586
Mailing Address - Country:US
Mailing Address - Phone:651-423-3300
Mailing Address - Fax:651-423-5252
Practice Address - Street 1:15083 CRESTONE AVE W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-4586
Practice Address - Country:US
Practice Address - Phone:651-423-3300
Practice Address - Fax:651-423-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02646Medicare PIN