Russell John Avery Sr., LICENSED OPTICIAN
Individual provider Active NPI Optician · Endicott, NY
NPI 1467598334 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1467598334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 6965 (NY)
- Practice address
- Knauf Optical
235 Vestal Ave.
Endicott, NY 13760 - Phone
- (607) 748-0765
- Fax
- (607) 748-0765
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6965 | NY | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Knauf Optical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 6965 | NY | Yes |
Addresses
Primary practice location
Knauf Optical
235 Vestal Ave.
Endicott, NY 13760
Mailing address
2209 Glenwood Rd
Vestal, NY 13850-5715
Phone (607) 748-5463
Other providers in Endicott, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.