Provider Demographics
NPI:1104919059
Name:CROSIER, RUSSELL KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:KEITH
Last Name:CROSIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 MATLOCK RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1558
Mailing Address - Country:US
Mailing Address - Phone:817-557-4100
Mailing Address - Fax:817-557-4176
Practice Address - Street 1:5425 MATLOCK RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1558
Practice Address - Country:US
Practice Address - Phone:817-557-4100
Practice Address - Fax:817-557-4176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4961TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0191744-01Medicaid
TXU52674Medicare UPIN
TX00E01VMedicare ID - Type Unspecified