Russell P Edwards, MD Apc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G57008 Issued in CA

Legal business name

RUSSELL P EDWARDS, MD APC

Practice address

3969 4TH Ave
Suite 301
San Diego, CA 92103-3165

Phone

(619) 291-6191

Fax

(619) 291-0049

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Russell P Edwards, M.D.

Title

Owner

Phone

(619) 291-6191

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1093854705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3969 4TH AVE",
            "address_2": "SUITE 301",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033165",
            "telephone_number": "619-291-6191",
            "fax_number": "619-291-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3969 4TH AVE",
            "address_2": "SUITE 301",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033165",
            "telephone_number": "619-291-6191",
            "fax_number": "619-291-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL P EDWARDS, MD APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-291-6191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G57008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G570080",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "WG57008B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valentina Russack, MD
• Jayna Russel
• Russell B Hays MD Inc
• Russell Bruce Hubbard MD Inc
• Russell Chiropractic & Acupuncture, Inc
• Alexius Russell
• Bethany Zylstra Coleman Russell, OT
• Bonnie Russell, B.S.
• Brian Russell
• Briana Russell, SLP

• Ophthalmology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; 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.