Provider Demographics
NPI:1942501770
Name:CLAIR, ROSS IRA (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:IRA
Last Name:CLAIR
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:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:5333 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53402-2032
Practice Address - Country:US
Practice Address - Phone:262-752-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3177035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100215187Medicaid