Provider Demographics
NPI:1316668056
Name:RUSSELL, CLAIRE CATHERINE (OD)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:CATHERINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 W 2ND ST UNIT 384
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3899
Mailing Address - Country:US
Mailing Address - Phone:704-689-7209
Mailing Address - Fax:
Practice Address - Street 1:202 W CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3012
Practice Address - Country:US
Practice Address - Phone:336-248-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist