Provider Demographics
NPI:1629324256
Name:BRANDON K ROSS OD PC
Entity Type:Organization
Organization Name:BRANDON K ROSS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-353-5090
Mailing Address - Street 1:311 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4315
Mailing Address - Country:US
Mailing Address - Phone:580-353-5090
Mailing Address - Fax:580-353-5105
Practice Address - Street 1:311 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4315
Practice Address - Country:US
Practice Address - Phone:580-353-5090
Practice Address - Fax:580-353-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty