MEDICARE: DR. TIMOTHY ADKINS ROSS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OPT001089	GA
2	152WL0500X	Low Vision Rehabilitation Optometrist	OPT001089	GA
3	152WP0200X	Pediatric Optometrist	OPT001089	GA
4	152WS0006X	Sports Vision Optometrist	OPT001089	GA
5	152WV0400X	Vision Therapy Optometrist	OPT001089	GA
6	152WX0102X	Occupational Vision Optometrist	OPT001089	GA
7	152W00000X	Optometrist	OPT001089	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1107013	OTHER	GA	UNITED HEALTHCARE
2	11473020	OTHER		CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033143615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ADKINS ROSS OD

Provider Business Mailing Address
First Line	:	4521 17TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-660-0191
Fax Number	:	706-596-8388

Provider Business Practice Location Address
First Line	:	4521 17TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-660-0191
Fax Number	:	706-596-8388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/03/2019

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