Provider Demographics
NPI:1306926068
Name:MARINGER, RUSSELL A (OD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:A
Last Name:MARINGER
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 1:3972 S MEMORIAL SHOREWAY DR
Mailing Address - Street 2:EYE SURGERY CONSULTANTS INC.
Mailing Address - City:LAKESIDE MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-2374
Mailing Address - Country:US
Mailing Address - Phone:567-230-0263
Mailing Address - Fax:866-651-8467
Practice Address - Street 1:142 W WATER ST STE L
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1373
Practice Address - Country:US
Practice Address - Phone:419-898-1918
Practice Address - Fax:866-651-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5494/T2406207W00000X
OH5494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00151040OtherRAILROAD MEDICARE PIN
OH2498208OtherUNITED HEALTHCARE
OH2499998Medicaid
OH000000341090OtherANTHEM
OHP00441299OtherRAILROAD MEDICARE PIN
OHV01004Medicare UPIN
OH2499998Medicaid
OHP00151040OtherRAILROAD MEDICARE PIN