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General NPI Number Information
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NPI Number | 1487897260
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Entity Type | Individual
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Provider Name | SHANDA PEARL ROSS O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 10 INDUSTRIAL WAY E STE 2
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City | EATONTOWN
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State | NJ
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Zip | 07724-3333
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Country | US
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Telephone | 812-677-1186
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Fax |
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Provider Business Mailing Address
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Address Line | 10 INDUSTRIAL WAY E STE 2
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City | EATONTOWN
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State | NJ
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Zip | 07724-3333
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Country | US
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Telephone | 812-677-1186
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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 | 27OA00617500
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License Number State | NJ
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