Provider Demographics
NPI:1063529725
Name:ROSS EYECARE GROUP, P.C.
Entity type:Organization
Organization Name:ROSS EYECARE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTTERWICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-233-3513
Mailing Address - Street 1:2625 PIEDMONT RD NE
Mailing Address - Street 2:SUITE G36
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3086
Mailing Address - Country:US
Mailing Address - Phone:404-233-3513
Mailing Address - Fax:404-814-0184
Practice Address - Street 1:2625 PIEDMONT RD NE
Practice Address - Street 2:SUITE G36
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3086
Practice Address - Country:US
Practice Address - Phone:404-233-3513
Practice Address - Fax:404-814-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0174090001Medicare NSC