Basic Information
| Provider Information | |||||||||
| NPI: | 1013956796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 396 ROUTE 6 AND 209 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183379490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702969696 | ||||||||
| FaxNumber: | 5704090316 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 FROEHLICH FARM BLVD | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117972922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163645400 | ||||||||
| FaxNumber: | 5166773653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 220613 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.