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NPI Code Detail

MEDICARE: JAMES ERIC DELLO RUSSO OD

MEDICARE:   JAMES ERIC DELLO RUSSO  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist27TO00121200NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11P00085267OTHERNJRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12K5292OTHERNJHEALTHNET
23229881OTHERNJAETNA HMO
3NJ1300OTHERNJEYE MED VISION
412056OTHERNJSPECTERA VISION
52128912000OTHERNJAMERIHEALTH
67386502OTHERNJAETNA PPO
78217500OTHERNJGHI PPO
891002286600OTHERNJAMERICHOICE
91784R1OTHERNJEMPIRE BCBS
1052146OTHERNJDAVIS VISION
12P2738259OTHERNJOXFORD

General Provider Information

NPI Number : 1306856091
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES ERIC DELLO RUSSO OD
Provider Business Mailing Address
First Line : 1 NORTH WASHINGTON AVE
Second Line :
City : BERGENFIELD
State : NJ
Zip : 07621
Country : US
Telephone Number : 201-384-7333
Fax Number : 201-385-3881
Provider Business Practice Location Address
First Line : 1 NORTH WASHINGTON AVE
Second Line :
City : BERGENFIELD
State : NJ
Zip : 07621
Country : US
Telephone Number : 201-384-7333
Fax Number : 201-385-3881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/29/2008

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Directions to “ JAMES ERIC DELLO RUSSO OD” Practice Location

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