Provider Demographics
NPI:1043238199
Name:ROSS, CARL H (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:H
Last Name:ROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4775 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3592
Mailing Address - Country:US
Mailing Address - Phone:281-367-5335
Mailing Address - Fax:281-292-4688
Practice Address - Street 1:4775 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 230B
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3592
Practice Address - Country:US
Practice Address - Phone:281-367-5335
Practice Address - Fax:281-292-4688
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15645Medicare UPIN
TX0403010001Medicare NSC
TX8F0726Medicare ID - Type Unspecified