=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588704779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSS MATTHEW OSTROFF O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E STREET RD
-----------------------------------------------------
City | WARMINSTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18974-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-957-4783
-----------------------------------------------------
Fax | 215-675-2405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 VILLAGE DR
-----------------------------------------------------
City | NORTH WALES
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19454-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-718-9863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001538
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------