David R Russell OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

293T Issued in WY

Legal business name

DAVID R RUSSELL OD

Practice address

720 6TH St
Evanston, WY 82930

Phone

(307) 789-1500

Fax

(307) 789-0077

NPI assigned

Jul 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David R Russell, ODNPI 1992898894

Title

President

Phone

(307) 789-1500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Accurate Eye Care Doing business as
• Vision Source Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Ray Russell, O.D.

  • Optometrist
  • Evanston, WY
  • NPI 1992898894
  Medicare reassignment NPD Authorized official
• Paul Robert Barnard, O.D.

  • Optometrist
  • Evanston, WY
  • NPI 1164623229
  NPD (past)
• Ian T Christensen, MD

  • Ophthalmology Physician
  • Park City, UT
  • NPI 1104449875
  NPD (past)
• Christopher Bryant Smith, M.D.

  • Ophthalmology Physician
  • Park City, UT
  • NPI 1356780076
  NPD (past)

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533168000000",
    "number": "1700076643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 MAIN ST",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303441",
            "telephone_number": "307-789-1500",
            "fax_number": "307-789-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 6TH ST",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "82930",
            "telephone_number": "307-789-1500",
            "fax_number": "307-789-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID R RUSSELL OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2018-08-02",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-789-1500",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WY",
            "license": "293T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121954500",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Accurate Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• County of Uinta
• County of Uinta
• Marjorie M Coyle
• Shad Fredrick Crapo, PA-C
• D McKay Francom DDS
• Davidson Chiropractic Clinic - Evanston LLC
• Carol Diane Davis, OTR/L
• Kenneth Casey Davis, D.C.
• Denise Debarre, PHD
• Justin T Dennis, P.T.

• Optometrist in Evanston, WY
• Providers in Evanston, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.