Provider Demographics
NPI:1538150578
Name:ROSS, JONATHAN E (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
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 1:500 LEWIS RUN RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3056
Mailing Address - Country:US
Mailing Address - Phone:412-466-9582
Mailing Address - Fax:412-466-7906
Practice Address - Street 1:500 LEWIS RUN RD
Practice Address - Street 2:SUITE 218
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-466-9582
Practice Address - Fax:412-466-7906
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA266195OtherADVANTRA
PA251100359004OtherCAHMPVA/ TRICARE
PA266195OtherHEALTH AMERICA/ HEALTH AS
PACIGNAOther9872744
PA1054419OtherAETNA HMO
PA7128770OtherAETNA COMMERCIAL
PA101541859OtherMEDICAID PROVIDER #
PA410781OtherUPMC
PA104961Medicare PIN
PA266195OtherHEALTH AMERICA/ HEALTH AS
PA101541859OtherMEDICAID PROVIDER #