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General NPI Number Information
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NPI Number | 1013051358
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Entity Type | Individual
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Provider Name | SUSAN ROSS O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 18216 SLOANE AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3110
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Country | US
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Telephone | 216-521-2020
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Fax | 216-521-6088
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Provider Business Mailing Address
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Address Line | 29665 CEDAR RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4411
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Country | US
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Telephone | 216-521-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3491 T1509
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License Number State | OH
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