Healthcare Provider Details

I. General information

NPI: 1124684774
Provider Name (Legal Business Name): ERIN MICHELLE ROSS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MERCY HEALTH BLVD STE 220
CINCINNATI OH
45211-1106
US

IV. Provider business mailing address

4445 LAKE FOREST DR
BLUE ASH OH
45242-3739
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-3060
  • Fax:
Mailing address:
  • Phone: 513-569-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: