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General NPI Number Information
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NPI Number | 1770050700
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL
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Gender | Male
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 1105 BROAD ST
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City | ASHLAND
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State | OH
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Zip | 44805-2910
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Country | US
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Telephone | 419-605-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 BROAD ST
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City | ASHLAND
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State | OH
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Zip | 44805-2910
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Country | US
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Telephone | 419-605-0570
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Fax |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | IL.03374
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License Number State | OH
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