Provider Demographics
NPI:1699735829
Name:RUSSELL, BELINDA D (OD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:D
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 1:5187 US ROUTE 60 EAST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-691-8800
Mailing Address - Fax:304-302-0221
Practice Address - Street 1:5187 US ROUTE 60 EAST
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-691-8800
Practice Address - Fax:304-302-0221
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1025-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601625Medicaid
WV3810003533Medicaid
KY77001378Medicaid
WV4169132Medicare ID - Type Unspecified
OH2601625Medicaid