Provider Demographics
NPI:1013189042
Name:EDWARD ROSS, OD
Entity type:Organization
Organization Name:EDWARD ROSS, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-373-9767
Mailing Address - Street 1:500 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITCAIRN
Mailing Address - State:PA
Mailing Address - Zip Code:15140-1449
Mailing Address - Country:US
Mailing Address - Phone:412-373-9767
Mailing Address - Fax:
Practice Address - Street 1:500 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITCAIRN
Practice Address - State:PA
Practice Address - Zip Code:15140-1449
Practice Address - Country:US
Practice Address - Phone:412-373-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD ROSS,D
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1576332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427288Medicaid
PA0490900002Medicare NSC
PAT30369Medicare UPIN