| Doctor Name: | MR. JOHN ROSS |
| NPI Number: | 1174763072 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LDO |
| License Number: | LDO002127 |
| Business Practice Address: | 520 Eagle Blvd Kingsland, GA - 315486569 |
| Business Phone Number: | 8437095271 |
| Business Fax Number: | |
| Mailing Address: | 520 Eagle Blvd, KINGSLAND |
| State: | GA |
| Postal Code: | 315486569 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2009 |
| NPI Last Update Date: | 03/05/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | LDO002127 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |