Provider Demographics
NPI:1053581314
Name:E. RUSSELL DRESSEN, JR. OD
Entity type:Organization
Organization Name:E. RUSSELL DRESSEN, JR. OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DRESSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:325-677-6331
Mailing Address - Street 1:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2994
Mailing Address - Country:US
Mailing Address - Phone:325-677-6331
Mailing Address - Fax:325-677-3112
Practice Address - Street 1:942 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4104
Practice Address - Country:US
Practice Address - Phone:325-677-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2170TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E69WOtherBLUE CROSS BLUE SHIELD OF
TX0194623-01Medicaid
TX0194623-01Medicaid
TX00E69WOtherBLUE CROSS BLUE SHIELD OF