=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013189042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD ROSS, OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2008
-----------------------------------------------------
Last Update Date | 03/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 BROADWAY ST
-----------------------------------------------------
City | PITCAIRN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15140-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-373-9767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 BROADWAY ST
-----------------------------------------------------
City | PITCAIRN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15140-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-373-9767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EDWARD ROSS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 412-373-9767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | OEG1576
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------