Susan Melissa Russell, LDO
Individual provider Active NPI Optician · Hanson, KY
NPI 1568191997 · NPPES record last updated Jun 9, 2022
Key facts
- NPI
- 1568191997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 110443 (KY)
- Practice address
- 420 Factory Outlet Dr
Hanson, KY 42413-9513 - Phone
- (270) 821-7177
- Fax
- (270) 322-8192
- NPI assigned
- Jun 9, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 110443 | KY | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 110443 | KY | Yes |
Addresses
Primary practice location
420 Factory Outlet Dr
Hanson, KY 42413-9513
Mailing address
420 Factory Outlet Dr
Hanson, KY 42413-9513
Phone (270) 821-7177
Other providers in Hanson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2022. 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.