Provider Demographics
NPI:1578594354
Name:ROSS, ANNA J (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5405
Mailing Address - Country:US
Mailing Address - Phone:718-654-7122
Mailing Address - Fax:
Practice Address - Street 1:2241 ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5405
Practice Address - Country:US
Practice Address - Phone:718-654-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV005997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC50321Medicare ID - Type Unspecified
NYU71154Medicare UPIN