Individual
FREDRIC JAY GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 WIMBLEDON SQ, STE E, CHESAPEAKE, VA 23320-4945
(757) 547-9830
(757) 548-0721
Mailing address
PO BOX 1290, FOREST, VA 24551-1290
(434) 385-5600
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101046621
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058244
ANTHEM BC/BS
VA
01
—
0800124
UNITED HEALTH CARE
VA
01
—
15510
OPTIMA
VA
01
—
180016154
RR MEDIACRE
VA
05
—
6306616
—
VA
01
—
890512X
NC MEDICAID
NC
Enumeration date
06/16/2005
Last updated
02/02/2021
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