Provider Demographics
NPI:1114139680
Name:TAMI R ROSS, PC
Entity Type:Organization
Organization Name:TAMI R ROSS, PC
Other - Org Name:LEADERSHIP SQUARE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:RA
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-232-0877
Mailing Address - Street 1:211 N ROBINSON AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-7109
Mailing Address - Country:US
Mailing Address - Phone:405-232-0877
Mailing Address - Fax:405-232-5956
Practice Address - Street 1:211 N ROBINSON AVE
Practice Address - Street 2:STE 130
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-7109
Practice Address - Country:US
Practice Address - Phone:405-232-0877
Practice Address - Fax:405-232-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1285638627OtherIND. NPI
OK1285638627OtherIND. NPI
OK1017340001Medicare NSC
OK400522539Medicare PIN
OKU04490Medicare UPIN