Individual provider Active NPI

Giuseppina M Russo, OD

  • Optometrist
  • Medford, NY
National Provider Identifier
1033170733
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV0063921 Issued in NY
Practice address
2799 RT 112
Davis Vision at King Kuhlen Shopping Center
Medford, NY 11763
Phone
(631) 289-3937
Fax
(631) 207-0913
NPI assigned
Mar 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV0063921 NY Primary

Addresses

Primary practice location

2799 RT 112
Davis Vision at King Kuhlen Shopping Center
Medford, NY 11763

Mailing address

2921 Erie Blvd E
Syracuse, NY 13224
Phone (315) 445-7465

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

LicenseStateTypeSpecialty
TUV0063921NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Empire Vision Center Inc Optometrist Past Accepting new patients
Empire Vision Center, Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561680000000",
    "number": "1033170733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 ERIE BLVD E",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13224",
            "telephone_number": "315-445-7465",
            "fax_number": "315-445-7675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 RT 112",
            "address_2": "DAVIS VISION AT KING KUHLEN SHOPPING CENTER",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "11763",
            "telephone_number": "631-289-3937",
            "fax_number": "631-207-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "GIUSEPPINA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2019-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV0063921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.