Organization
DAVID G. GROSS, D.O., P.C.
Active
Other names
Deen-Gross Eye Centers
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID G GROSS D.O. (OWNER)
(219) 769-8989
Entity
Organization
Contact information
Practice address
6111 HARRISON ST, SUITE 120, MERRILLVILLE, IN 46410-2969
(219) 980-6143
(219) 980-6146
Mailing address
6111 HARRISON ST, SUITE 120, MERRILLVILLE, IN 46410-2969
(219) 980-6143
(219) 980-6146
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
50004042A
IN
207W00000X
Ophthalmology Physician
Primary
50004042A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000105018
ANTHEM
IN
05
—
100169420
—
IN
Enumeration date
06/04/2010
Last updated
06/04/2010
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