Sam O Russell III, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

601 Issued in SC

Practice address

240 W Evans St
Florence, SC 29501-3428

Phone

(843) 662-3278

Fax

(843) 667-6090

NPI assigned

May 1, 2006

Last updated

Apr 24, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1063479111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W EVANS ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295013428",
            "telephone_number": "843-662-3278",
            "fax_number": "843-667-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W EVANS ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295013428",
            "telephone_number": "843-662-3278",
            "fax_number": "843-667-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "SAM",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D06018",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Melissa Russell, PHARM D
• Bradley Stokes Russell, MD
• Francheska L Russell, LPC
• Leslie L Russell, LMSW
• Nina Marie Russell, FNP-C
• RX Express Inc
• Eva Maria Rzucidlo, MD
• S & a Medical Company
• S Edward Parker DDS PA
• S.C. Department of Health and Environmental Control

• Optometrist in Florence, SC
• Providers in Florence, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.