Provider Demographics
NPI:1447435797
Name:RUSSELL WOHL OD LLC
Entity type:Organization
Organization Name:RUSSELL WOHL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-249-0052
Mailing Address - Street 1:255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2619
Mailing Address - Country:US
Mailing Address - Phone:516-249-0052
Mailing Address - Fax:516-249-7000
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2619
Practice Address - Country:US
Practice Address - Phone:516-249-0052
Practice Address - Fax:516-249-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0517050002Medicare NSC
NYA100030762Medicare PIN