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General NPI Number Information
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NPI Number | 1891918355
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Entity Type | Individual
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Provider Name | RUSSELL M WEBSTER O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 2214 RICHLAND MALL
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City | MANSFIELD
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State | OH
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Zip | 44906-1249
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Country | US
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Telephone | 419-529-8085
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 867
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City | ASHLAND
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State | OH
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Zip | 44805-0867
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Country | US
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Telephone | 419-529-8085
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5603
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License Number State | OH
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