Provider Demographics
NPI:1881697753
Name:ROSS, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
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 1:270 CLOSTER DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2616
Mailing Address - Country:US
Mailing Address - Phone:201-768-2433
Mailing Address - Fax:201-768-1861
Practice Address - Street 1:270 CLOSTER DOCK RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2616
Practice Address - Country:US
Practice Address - Phone:201-768-2433
Practice Address - Fax:201-768-1861
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ230784YFXKOtherPTAN: ASSOCIATED WITH NPI
NJU20146Medicare UPIN