1033387626 NPI number — ROSS OPTICIANS CO., INC.

Table of content: (NPI 1033387626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033387626 NPI number — ROSS OPTICIANS CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS OPTICIANS CO., INC.
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:
Provider Other Organization Name Type Code:
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:
1033387626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MILLTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10509-4344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-279-6179
Provider Business Mailing Address Fax Number:
845-279-3619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 MILLTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10509-4344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-279-6179
Provider Business Practice Location Address Fax Number:
845-279-3619
Provider Enumeration Date:
02/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-279-6179

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0031321 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 0060752 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 44128 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C95981 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 441580088 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2671193 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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