Provider Demographics
NPI:1487897260
Name:ROSS, SHANDA PEARL (OD)
Entity type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:PEARL
Last Name:ROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 INDUSTRIAL WAY E STE 2
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3333
Mailing Address - Country:US
Mailing Address - Phone:812-677-1186
Mailing Address - Fax:
Practice Address - Street 1:10 INDUSTRIAL WAY E STE 2
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3333
Practice Address - Country:US
Practice Address - Phone:812-677-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00617500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist