Provider Demographics
NPI:1083804074
Name:RUSSELL A MARINGER OD INC.
Entity type:Organization
Organization Name:RUSSELL A MARINGER OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:419-447-5616
Mailing Address - Street 1:455 E MARKET ST
Mailing Address - Street 2:STE F
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1769
Mailing Address - Country:US
Mailing Address - Phone:419-447-5616
Mailing Address - Fax:866-462-0224
Practice Address - Street 1:455 E MARKET ST
Practice Address - Street 2:SUITE F
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1707
Practice Address - Country:US
Practice Address - Phone:419-447-5616
Practice Address - Fax:866-462-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499998Medicaid
OH2499998Medicaid
9346651Medicare PIN