Provider Demographics
NPI:1598551798
Name:ROSS, ERICK ARNOLD (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:ARNOLD
Last Name:ROSS
Suffix:
Gender:
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4315
Mailing Address - Country:US
Mailing Address - Phone:321-243-5255
Mailing Address - Fax:
Practice Address - Street 1:601 E STRAWBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4733
Practice Address - Country:US
Practice Address - Phone:321-301-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5141156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter