Provider Demographics
NPI:1932136819
Name:ROSS, WILLIAM JACOB (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACOB
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 1:161 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1708
Mailing Address - Country:US
Mailing Address - Phone:973-377-3644
Mailing Address - Fax:973-377-1413
Practice Address - Street 1:161 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1708
Practice Address - Country:US
Practice Address - Phone:973-377-3644
Practice Address - Fax:973-377-1413
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2528152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1271008Medicaid
NJ0112767000OtherAMERIHEALTH
NJ187927OtherUNITED HEALTHCARE
NJ516518OtherAETNA
NJP830239OtherOXFORD
NJ521672Medicare ID - Type Unspecified
NJP830239OtherOXFORD