Provider Demographics
NPI:1508600834
Name:ROSS, BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
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 1:161 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-0202
Mailing Address - Fax:732-223-0490
Practice Address - Street 1:161 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-223-0202
Practice Address - Fax:732-223-0490
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00727900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist