Provider Demographics
NPI:1447399019
Name:ROSS, JOHN ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
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 1:34 PRISCILLA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1524
Mailing Address - Country:US
Mailing Address - Phone:508-238-0306
Mailing Address - Fax:781-857-3071
Practice Address - Street 1:777 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2111
Practice Address - Country:US
Practice Address - Phone:781-857-1784
Practice Address - Fax:781-857-3071
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17940OtherSPECTERA
MA113443OtherEYEMED
MAW15892OtherBLUE CROSS
MA17940OtherSPECTERA
MARO459758Medicare ID - Type Unspecified