Provider Demographics
NPI:1851382683
Name:ROSS, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
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 1:500 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITCAIRN
Mailing Address - State:PA
Mailing Address - Zip Code:15140-1449
Mailing Address - Country:US
Mailing Address - Phone:412-373-9767
Mailing Address - Fax:
Practice Address - Street 1:500 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITCAIRN
Practice Address - State:PA
Practice Address - Zip Code:15140-1449
Practice Address - Country:US
Practice Address - Phone:412-373-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427288Medicare ID - Type Unspecified
PAT30369Medicare UPIN