Individual
FREDRIC JAY GROSS
Active
Individual
FREDRIC JAY GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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