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General NPI Number Information
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NPI Number | 1649763988
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Entity Type | Organization
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Legal Business Name | ROSS W COLLINS OD LLC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 407 CORPORATE CENTER DR STE C
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City | VANDALIA
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State | OH
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Zip | 45377-1177
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Country | US
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Telephone | 937-898-9333
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Fax | 937-898-0643
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Provider Business Mailing Address
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Address Line | 407 CORPORATE CENTER DR STE C
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City | VANDALIA
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State | OH
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Zip | 45377-1177
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Country | US
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Telephone | 937-898-9333
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Fax | 937-898-0643
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSS W COLLINS
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Credential | OD
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Telephone | 937-898-9333
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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 | 5709
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License Number State | OH
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