Healthcare Provider Details

I. General information

NPI: 1285567248
Provider Name (Legal Business Name): SPACECOASTPOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E STRAWBRIDGE AVE
MELBOURNE FL
32901-4733
US

IV. Provider business mailing address

601 E STRAWBRIDGE AVE
MELBOURNE FL
32901-4733
US

V. Phone/Fax

Practice location:
  • Phone: 321-499-3330
  • Fax:
Mailing address:
  • Phone: 321-499-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. ERICK ARNOLD ROSS
Title or Position: PRESIDENT
Credential: LICENSED OPTICIAN
Phone: 321-499-3330