Provider Demographics
NPI:1003194861
Name:ROSS, BRANDON KNOX (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KNOX
Last Name:ROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 NW CACHE RD.
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4315
Mailing Address - Country:US
Mailing Address - Phone:580-353-5090
Mailing Address - Fax:580-353-5105
Practice Address - Street 1:4250 NW CACHE RD.
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4315
Practice Address - Country:US
Practice Address - Phone:580-353-5090
Practice Address - Fax:580-353-5105
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist