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NPI Code Detail

MEDICARE: DR. ALAN ROSS O.D.

MEDICARE: DR. ALAN ROSS O.D.
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
1152W00000XOptometrist3598NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1230784YFXKOTHERNJPTAN: ASSOCIATED WITH NPI

General Provider Information

NPI Number : 1881697753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALAN ROSS O.D.
Provider Business Mailing Address
First Line : 270 CLOSTER DOCK RD
Second Line :
City : CLOSTER
State : NJ
Zip : 07624-2616
Country : US
Telephone Number : 201-768-2433
Fax Number : 201-768-1861
Provider Business Practice Location Address
First Line : 270 CLOSTER DOCK RD
Second Line :
City : CLOSTER
State : NJ
Zip : 07624-2616
Country : US
Telephone Number : 201-768-2433
Fax Number : 201-768-1861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 10/05/2015

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