Healthcare Provider Details

I. General information

NPI: 1578543161
Provider Name (Legal Business Name): JOHN SCOTT ROSSI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 NORTH PALM AVENUE
ONTARIO CA
91762
US

IV. Provider business mailing address

615 NORTH PALM AVENUE
ONTARIO CA
91762
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-4162
  • Fax: 909-984-3657
Mailing address:
  • Phone: 909-986-4162
  • Fax: 909-984-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: