Russell Auclair, O.D.
Individual provider Active NPI Optometrist · Providence, RI
NPI 1528099405 · NPPES record last updated Oct 1, 2008
Key facts
- NPI
- 1528099405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODTG 00507 (RI)
- Practice address
- 780 N Main St
Providence, RI 02904-5706 - Phone
- (401) 331-1108
- Fax
- (401) 331-1179
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODTG 00507 | RI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aeg Rhode Island Professional, PC | Optometrist | Past |
Accepting new patients |
| Advanced Eye Care Associates | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODTG 00507 | RI | Yes |
Addresses
Primary practice location
780 N Main St
Providence, RI 02904-5706
Mailing address
780 N Main St
Providence, RI 02904-5706
Phone (401) 331-1108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9009874 | Medicaid | RI |
Other providers in Providence, RI
- Naureen Attiullah
- Eilean L. Attwood
- Jared Au Yeung
- Claude Michelle Aubourg
- Susan Aubut
- Brett C Auclaire
- Myah Audette
- Fernando Augusto
- Seerat Kaur Aujla
- Megan Auld
All providers in Providence, RI · Optometrist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2008. 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.