Provider Demographics
NPI:1386678068
Name:ROSS, PETER W (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:ROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0207
Mailing Address - Country:US
Mailing Address - Phone:408-866-2020
Mailing Address - Fax:408-370-3937
Practice Address - Street 1:338 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0207
Practice Address - Country:US
Practice Address - Phone:408-866-2020
Practice Address - Fax:408-370-3937
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5098T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09872Medicare UPIN
CASD0050980Medicare PIN