Provider Demographics
NPI:1356371108
Name:ROSS, NANCY C (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:C
Last Name:ROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 L ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4909
Mailing Address - Country:US
Mailing Address - Phone:202-659-5575
Mailing Address - Fax:202-296-9678
Practice Address - Street 1:2021 L ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4909
Practice Address - Country:US
Practice Address - Phone:202-659-5575
Practice Address - Fax:202-296-9678
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP563152W00000X
MDTA0924152W00000X
VA0601001291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD747LP899Medicare PIN
MDV12255Medicare UPIN