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General NPI Number Information
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NPI Number | 1033170733
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Entity Type | Individual
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Provider Name | GIUSEPPINA M RUSSO OD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 2799 RT 112 DAVIS VISION AT KING KUHLEN SHOPPING CENTER
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-289-3937
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Fax | 631-207-0913
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Provider Business Mailing Address
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Address Line | 2921 ERIE BLVD E
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City | SYRACUSE
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State | NY
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Zip | 13224
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Country | US
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Telephone | 315-445-7465
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Fax | 315-445-7675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV0063921
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License Number State | NY
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