Provider Demographics
NPI:1427259977
Name:RUSSELL, JAMES FRANK (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANK
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:FRANK
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:6448 BRANDYWINE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3520
Mailing Address - Country:US
Mailing Address - Phone:405-810-1090
Mailing Address - Fax:
Practice Address - Street 1:3431 S BOULEVARD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5475
Practice Address - Country:US
Practice Address - Phone:405-340-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK812OtherSTATE LICENSE
OK812OtherSTATE LICENSE