Penny Lee Russell, LDO ABO NCLE

Primary specialty

OpticianTaxonomy code 156FX1800X

License

DO7367 Issued in FL

Practice address

17105 San Carlos Blvd
Fort Myers Beach, FL 33931-5305

Phone

(239) 340-7071

Fax

(239) 466-9015

NPI assigned

May 9, 2023

Last updated

May 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1295425734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15186 IONA LAKES DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339081871",
            "telephone_number": "239-340-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17105 SAN CARLOS BLVD",
            "city": "FORT MYERS BEACH",
            "state": "FL",
            "postal_code": "339315305",
            "telephone_number": "239-340-7071",
            "fax_number": "239-466-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "PENNY",
        "middle_name": "LEE",
        "credential": "LDO ABO NCLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO7367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Craig Preiss, D.C.
• Palmer Reap, DPT
• Robert K. Rhee, M.D.
• Robert Difronzo
• Maydelis Eveling Rojas
• Priscilla Santiago-Maldonado, OT, DC, CLT
• Stephen F Scholle, MD
• Stephen F. Scholle MD PA (beach family medical clinic)
• Janet Stoff
• Sulan Services LLC

• Optician in Fort Myers Beach, FL
• Providers in Fort Myers Beach, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.