Provider Demographics
NPI:1710677661
Name:ROSS, EILEEN ELIZABETH (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:ROSS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:723A OLD WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4217
Mailing Address - Country:US
Mailing Address - Phone:570-251-9657
Mailing Address - Fax:570-251-9663
Practice Address - Street 1:723A OLD WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4217
Practice Address - Country:US
Practice Address - Phone:570-251-9657
Practice Address - Fax:570-251-9663
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
PA206506156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician