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NPI Code Detail

MEDICARE: TESS RUSSELL OD

MEDICARE: TESS RUSSELL OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT.007174OH

General Provider Information

NPI Number : 1013601186
Entity Type Code : Individual
Provider Name (Legal Business Name) : TESS RUSSELL OD
Provider Business Mailing Address
First Line : 510 HIGHLAND AVE # 345
Second Line :
City : MILFORD
State : MI
Zip : 48381-1516
Country : US
Telephone Number : 810-404-2962
Fax Number :
Provider Business Practice Location Address
First Line : 5203 MONROE ST
Second Line :
City : TOLEDO
State : OH
Zip : 43623-3139
Country : US
Telephone Number : 567-455-9232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2023
Last Update Date : 06/02/2023

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Directions to “ TESS RUSSELL OD” Practice Location

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