MEDICARE: RUSSELL EYECARE & ASSOCIATES LLC

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
1	152W00000X	Optometrist	2981	MN

General Provider Information

NPI Number	:	1437326493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL EYECARE & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	15 E MINNESOTA ST STE 107
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4691
Country	:	US
Telephone Number	:	320-433-4326
Fax Number	:	320-262-7072

Provider Business Practice Location Address
First Line	:	15 E MINNESOTA ST
Second Line	:	SUITE 107
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4689
Country	:	US
Telephone Number	:	320-231-9726
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. CHRISTIE RUSSELL-VILLNOW
Credential	:	OD
Telephone Number	:	320-224-3099

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	12/30/2020

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