Kevin Joseph Russell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

779 Issued in AZ

Practice address

2048 E. Baseline Rd.
Suite C6
Mesa, AZ 85204

Phone

(480) 245-8929

Fax

(480) 507-0836

NPI assigned

Nov 6, 2007

Last updated

Apr 24, 2018By 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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Becken Vision Solutions, PLLC

  • Optometrist
  • Queen Creek, AZ
  • NPI 1770851974
  Medicare reassignment NPD
• Dr. Simon Zmyslinski & Associates, P.L.L.C.

  • Optometrist
  • Phoenix, AZ
  • NPI 1710213434
  Medicare reassignment NPD
• Luxottica of America Inc

  dba Lenscrafters #E895

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1194905257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23490 S. 201ST ST.",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "85142",
            "telephone_number": "480-245-8929",
            "fax_number": "480-507-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2048 E. BASELINE RD.",
            "address_2": "SUITE C6",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85204",
            "telephone_number": "480-245-8929",
            "fax_number": "480-507-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KEVIN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-06",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell D. Meldrum, M.D. PLLC
• Ann J Russell, P.A.
• Comonique Russell
• Edward John Russell III, COTAL
• Helen Russell, CLINICAL LIAISON BHT
• Kristen Russell
• Sara Anne Russell, LPC
• Stuart Russell
• Tara Nicole Russell, MS, BCBA, LBA
• Antonio Joseph Russo

• Optometrist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.