Provider Demographics
NPI:1508877549
Name:ZELDES, ROSS EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:EDWARD
Last Name:ZELDES
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 1:1268 MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-666-5431
Mailing Address - Fax:860-666-5433
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-666-5431
Practice Address - Fax:860-666-5433
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4232995OtherAETNA
CT090002162CT07OtherBLUE CROSS
CT4075313Medicaid
CT4232995OtherAETNA
CT410000414Medicare ID - Type Unspecified
CT4075313Medicaid