1114139680 NPI number — TAMI R ROSS, PC

Table of content: (NPI 1114139680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114139680 NPI number — TAMI R ROSS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMI R ROSS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEADERSHIP SQUARE EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114139680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 N ROBINSON AVE
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73102-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-232-0877
Provider Business Mailing Address Fax Number:
405-232-5956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 N ROBINSON AVE
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73102-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-232-0877
Provider Business Practice Location Address Fax Number:
405-232-5956
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
RA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-232-0877

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2025 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1285638627 . This is a "IND. NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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