Provider Demographics
NPI:1205984564
Name:ROSSON, JAMES DARRYL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DARRYL
Last Name:ROSSON
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 1:720 WATER CREST CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1112
Mailing Address - Country:US
Mailing Address - Phone:903-567-4686
Mailing Address - Fax:903-567-4199
Practice Address - Street 1:603 E HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2420
Practice Address - Country:US
Practice Address - Phone:903-567-4686
Practice Address - Fax:903-567-4199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03087TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093188302Medicaid
TX751836056OtherTAX ID
TX751836056OtherTAX ID
TX093188302Medicaid