Healthcare Provider Details

I. General information

NPI: 1801934526
Provider Name (Legal Business Name): HAROLD S ROSS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 PRE EMPTION RD
GENEVA NY
14456-1336
US

IV. Provider business mailing address

738 PRE EMPTION RD
GENEVA NY
14456-1336
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-4922
  • Fax: 315-789-1791
Mailing address:
  • Phone: 315-789-4922
  • Fax: 315-789-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number127211
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number127211
License Number StateNY

VIII. Authorized Official

Name: DR. HAROLD S ROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 315-789-4922