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General NPI Number Information
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NPI Number | 1407554801
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Entity Type | Individual
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Provider Name | MARY JUNE ROSS LDO
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 7725 HOKE RD
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City | ENGLEWOOD
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State | OH
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Zip | 45315-9725
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Country | US
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Telephone | 937-836-9303
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Fax | 937-836-9308
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Provider Business Mailing Address
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Address Line | 7725 HOKE RD
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City | ENGLEWOOD
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State | OH
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Zip | 45315-9725
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Country | US
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Telephone | 937-836-9303
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Fax | 937-836-9308
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | OP.6765SC
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License Number State | OH
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