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General NPI Number Information
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NPI Number | 1356678155
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Entity Type | Individual
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Provider Name | ROBYN A RUSSELL O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 735 N 6TH AVE
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City | WAUCHULA
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State | FL
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Zip | 33873-2002
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Country | US
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Telephone | 863-773-3322
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Fax | 863-773-6458
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Provider Business Mailing Address
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Address Line | 21 S LAKE AVE
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City | AVON PARK
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State | FL
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Zip | 33825-3901
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Country | US
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Telephone | 863-385-7070
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Fax | 888-971-4152
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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 | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OPC4379
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPC4379
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4379
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License Number State | FL
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