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DR. RUSSELL NORMAN COTTERAL OD
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1619911047
Individual Registrant:DR. RUSSELL NORMAN COTTERAL OD
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
396 COLUSA AVE KENSINGTON, CA 94707-1209 US
Tel: 510-527-1714 Fax: 510-527-1715
Tel: 510-527-1714 Fax: 510-527-1715
Contact information for business:
396 COLUSA AVE KENSINGTON, CA 94707-1209 US
Tel: 510-527-1714 Fax: 510-527-1715
Tel: 510-527-1714 Fax: 510-527-1715
Registration Information:
NPI: 1619911047
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | CA | 9134 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| MEDICAL EYE SERVICES | 12452 | CA | 01 |
