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General NPI Number Information
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NPI Number | 1083804074
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Entity Type | Organization
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Legal Business Name | RUSSELL A MARINGER OD INC.
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 455 E MARKET ST SUITE F
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City | TIFFIN
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State | OH
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Zip | 44883-1707
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Country | US
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Telephone | 419-447-5616
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Fax | 866-462-0224
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Provider Business Mailing Address
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Address Line | 455 E MARKET ST STE F
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City | TIFFIN
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State | OH
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Zip | 44883-1769
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Country | US
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Telephone | 419-447-5616
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Fax | 866-462-0224
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RUSSELL A MARINGER
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Credential | OD, MS
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Telephone | 419-447-5616
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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 | 5494
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License Number State | OH
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