Healthcare Provider Details

I. General information

NPI: 1295881399
Provider Name (Legal Business Name): ROSS J SOMERS O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 WILSHIRE BLVD
SANTA MONICA CA
90403-5505
US

IV. Provider business mailing address

1531 WILSHIRE BLVD
SANTA MONICA CA
90403-5505
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-9999
  • Fax:
Mailing address:
  • Phone: 310-319-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 6592 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: