Active NPI
Alan S Russell, OD
- Optometrist
- Wichita, KS
National Provider Identifier
1255307278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1040-2
- Practice address
- 8111 E Harry
Wichita, KS 67207 - Phone
- (316) 685-7661
- Fax
- (316) 685-0227
- NPI assigned
- Feb 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1040-2 | KS | Primary |
Addresses
Primary practice location
8111 E Harry
Wichita, KS 67207
Mailing address
1851 N Webb Rd
Attn FLR2
Wichita, KS 67206-3413
Phone (316) 636-2010
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 |
|---|---|---|---|
| 1040-2 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grene Vision Group LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203984000000",
"number": "1255307278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1851 N WEBB RD",
"address_2": "ATTN FLR2",
"city": "WICHITA",
"state": "KS",
"postal_code": "672063413",
"telephone_number": "316-636-2010",
"fax_number": "613-858-3830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8111 E HARRY",
"city": "WICHITA",
"state": "KS",
"postal_code": "67207",
"telephone_number": "316-685-7661",
"fax_number": "316-685-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ALAN",
"middle_name": "S",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-28",
"last_updated": "2008-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KS",
"license": "1040-2",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.