Provider Demographics
NPI:1093144859
Name:ROSS FAMILY OPTOMETRY, PC
Entity Type:Organization
Organization Name:ROSS FAMILY OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-523-6787
Mailing Address - Street 1:303 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47247-4718
Mailing Address - Country:US
Mailing Address - Phone:812-523-6787
Mailing Address - Fax:812-523-6969
Practice Address - Street 1:1600 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3560
Practice Address - Country:US
Practice Address - Phone:812-523-6787
Practice Address - Fax:812-523-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU58921Medicare UPIN
IN494430Medicare PIN