=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801934526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAROLD S ROSS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 738 PRE EMPTION RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-789-4922
-----------------------------------------------------
Fax | 315-789-1791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 738 PRE EMPTION RD
-----------------------------------------------------
City | GENEVA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14456-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-789-4922
-----------------------------------------------------
Fax | 315-789-1791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HAROLD S ROSS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-789-4922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 127211
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | 127211
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------