Provider Demographics
NPI:1962732594
Name:ROBERT A. ROSS, O.D., P.A.
Entity type:Organization
Organization Name:ROBERT A. ROSS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-452-8598
Mailing Address - Street 1:1600 W 38TH ST STE 406
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6407
Mailing Address - Country:US
Mailing Address - Phone:512-452-8598
Mailing Address - Fax:512-452-5883
Practice Address - Street 1:1600 W 38TH ST STE 406
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6407
Practice Address - Country:US
Practice Address - Phone:512-452-8598
Practice Address - Fax:512-452-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2521TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5715Medicare PIN