MEDICARE: DR. CHRISTIE JO RUSSELL-VILLNOW O.D.

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
1	152WV0400X	Vision Therapy Optometrist	2981	MN
2	152W00000X	Optometrist	2981	MN

General Provider Information

NPI Number	:	1538279575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIE JO RUSSELL-VILLNOW O.D.

Provider Business Mailing Address
First Line	:	15 E MINNESOTA ST STE 107
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4691
Country	:	US
Telephone Number	:	320-433-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 E MINNESOTA ST
Second Line	:	SUITE 107
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4689
Country	:	US
Telephone Number	:	320-433-4326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/30/2020

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