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General NPI Number Information
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NPI Number | 1821260787
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Entity Type | Organization
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Legal Business Name | TUCKER-ROSS EYE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 490 COVENTRY LN STE. 201
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7548
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Country | US
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Telephone | 815-455-5034
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Fax | 815-455-5041
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Provider Business Mailing Address
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Address Line | 490 COVENTRY LN STE. 201
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7548
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Country | US
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Telephone | 815-455-5034
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Fax | 815-455-5041
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | DR. MARK I ROSS
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Credential | O.D.
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Telephone | 815-455-5034
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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 |
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License Number State |
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