Healthcare Provider Details

I. General information

NPI: 1881033751
Provider Name (Legal Business Name): ERIC MICHAEL ROSS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 E HAMPDEN AVE
DENVER CO
80231-5414
US

IV. Provider business mailing address

1441 LITTLE RAVEN ST APT 2014
DENVER CO
80202-6429
US

V. Phone/Fax

Practice location:
  • Phone: 701-630-5255
  • Fax:
Mailing address:
  • Phone: 701-770-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number708
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number708
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number708
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number152W00000X
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0003575
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: