Active NPI
Russell Brian NG, O.D.
- Optometrist
- Citrus Heights, CA
National Provider Identifier
1013068576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10517TPG
- Practice address
- 6363 Auburn Blvd.
Citrus Heights, CA 95621 - Phone
- (916) 331-1222
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10517T | CA | |
| Optometrist | 152W00000X | 10517TPG | CA | Primary |
Addresses
Primary practice location
6363 Auburn Blvd.
Citrus Heights, CA 95621
Mailing address
6363 Auburn Blvd.
Citrus Heights, CA 95621
Phone (916) 331-1222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0105170 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10517T | CA | MD | Optometrist |
| 10517TPG | CA | MD | Optometrist |
| 10517 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753315200000",
"number": "1013068576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6363 AUBURN BLVD.",
"city": "CITRUS HEIGHTS",
"state": "CA",
"postal_code": "95621",
"telephone_number": "916-331-1222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6363 AUBURN BLVD.",
"city": "CITRUS HEIGHTS",
"state": "CA",
"postal_code": "95621",
"telephone_number": "916-331-1222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NG",
"first_name": "RUSSELL",
"middle_name": "BRIAN",
"name_prefix": "Mr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2025-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10517T",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10517TPG",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0105170",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Citrus Heights, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.