Individual
DR. DOUGLAS GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
207 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-5985
(320) 202-7890
Mailing address
207 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-5985
(320) 202-7890
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2083
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078223800
—
MN
01
—
22-24009
MEDICA
MN
01
—
410032600
RAILROAD MEDICARE
MN
01
—
82973GR
BLUE CROSS BLUE SHIELD
MN
01
—
HP27094
HEALTH PARTNERS
MN
Enumeration date
11/30/2005
Last updated
08/23/2010
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