Jerrold C Russell, OD

NPI #1679526990 in Columbus, Wisconsin

Provider Information

NPI Number: 1679526990
Entity Type: Individual
Name: Jerrold C Russell, OD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Optometrist
Credential: OD
Enumeration Date: May 18, 2006
Last Updated: Jan 22, 2016

Practice Location

Address: 1341 PARK AVE
City: Columbus
State: Wisconsin
ZIP Code: 53925-1614
Phone: (920) 623-2431

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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