Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2708 | OK |
NPI | 1003194861 |
---|---|
Provider Name | Dr. Brandon Knox Ross |
First Address | Lawton, OK 73505-4315 |
Second Address | Lawton, OK 73505-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 10/12/2014 |