Provider Demographics
NPI:1760673271
Name:COLLINS, ROSS W (OD, MS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:W
Last Name:COLLINS
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
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Mailing Address - Street 1:407 CORPORATE CENTER DR
Mailing Address - Street 2:STE C
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1165
Mailing Address - Country:US
Mailing Address - Phone:937-898-9333
Mailing Address - Fax:937-898-0643
Practice Address - Street 1:407 CORPORATE CENTER DR
Practice Address - Street 2:STE C
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1165
Practice Address - Country:US
Practice Address - Phone:937-898-9333
Practice Address - Fax:937-898-0643
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2780790Medicaid
OH2780790Medicaid