Jerrold C Russell, OD is a
Optometrist based in Columbus, Wisconsin. Jerrold C Russell is licensed to practice in Wisconsin (license number 2029-035) and his current practice location is
1341 Park Ave, Columbus, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(920) 623-2431.
NPI number for Jerrold C Russell is 1679526990 and his current mailing address is 1341 Park Ave, Columbus, Wisconsin. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1679526990.
Healthcare Provider's Profile
Full Name | Jerrold C Russell |
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Gender | Male |
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Speciality | Optometrist |
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Location | 1341 Park Ave, Columbus, Wisconsin |
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Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1679526990
- Provider Enumeration Date: 05/18/2006
- Last Update Date: 01/22/2016
Medical Identifiers
Medical identifiers for Jerrold C Russell such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1679526990 | NPI | - | NPPES |
1679526990 | Medicaid | WI | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
152W00000X | Optometrist | 2029-035 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jerrold C Russell is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jerrold C Russell, OD 1341 Park Ave, Columbus, WI 53925-1614 Ph: (920) 623-2431 | Jerrold C Russell, OD 1341 Park Ave, Columbus, WI 53925-1614 Ph: (920) 623-2431 |
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