Active NPI
Robert Edward Russo
- Optician
- Essex Junction, VT
National Provider Identifier
1831282904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 14
- Practice address
- 18 Railroad Street
Essex Junction, VT 05453 - Phone
- (802) 879-4515
- Fax
- (802) 879-4515
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 14 | VT | Primary |
Addresses
Primary practice location
18 Railroad Street
Essex Junction, VT 05453
Mailing address
PO Box 35
18 Railroad Street
Essex Junction, VT 05453
Phone (802) 879-4515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006615 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14 | VT | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831282904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 35",
"address_2": "18 RAILROAD STREET",
"city": "ESSEX JUNCTION",
"state": "VT",
"postal_code": "05453",
"telephone_number": "802-879-4515",
"fax_number": "802-879-4515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 RAILROAD STREET",
"city": "ESSEX JUNCTION",
"state": "VT",
"postal_code": "05453",
"telephone_number": "802-879-4515",
"fax_number": "802-879-4515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ROBERT",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "VT",
"license": "14",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006615",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Essex Junction, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.