Kurt Russell, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

3800 Issued in WA

Practice address

15808 Mill Creek Blvd
Suite 110
Mill Creek, WA 98012-1500

Phone

(425) 745-5650

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Liberty Lake Eyecare Center PSGroup PAC ID 2163323841, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Liberty Lake Eyecare Center PS

  • Optometrist
  • Liberty Lake, WA
  • NPI 1609889039

  Corneal and Contact Management

  Medicare reassignment Care Compare group NPD
• Mill Creek Eye and Contact Lens Clinic, Inc.

  • Optometrist
  • Mill Creek, WA
  • NPI 1194094490
  Medicare reassignment NPD

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394064000000",
    "number": "1710100532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13024 NE 121ST LN",
            "address_2": "APT. H-406",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980348045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15808 MILL CREEK BLVD",
            "address_2": "SUITE 110",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121500",
            "telephone_number": "425-745-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KURT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2014-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WA",
            "license": "3800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Rosas Goble, CTRS/R, OTR
• Kirsten Ross, PT
• Katelyn Ann Rowland, ARNP
• Jonathan Ruiz, DC
• Kerry M Russell-Olszewski, D.D.S.
• Anna Rymar
• Emilio Saenz IV
• Safeway Inc
• Joshua Sagraves
• Tariku C Sahele, PHARMD

• Corneal and Contact Management Optometrist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Corneal and Contact Management Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.