Individual
DR. KEVIN J GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
24020 JOHN T REID PKWY, SCOTTSBORO, AL 35768-2855
(256) 574-3491
(256) 259-5113
Mailing address
PO BOX 290, SECTION, AL 35771-0290
(256) 574-3491
(256) 259-5113
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-554-TA-220
AL
152WC0802X
Corneal and Contact Management Optometrist
S-554-TA-220
AL
152WL0500X
Low Vision Rehabilitation Optometrist
S-554-TA-220
AL
152WP0200X
Pediatric Optometrist
S-554-TA-220
AL
152WS0006X
Sports Vision Optometrist
S-554-TA-220
AL
152WV0400X
Vision Therapy Optometrist
S-554-TA-220
AL
152WX0102X
Occupational Vision Optometrist
S-554-TA-220
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059775
—
AL
01
—
51059775
BCBS
AL
01
—
630711357
TAX ID
AL
Enumeration date
10/20/2006
Last updated
05/17/2021
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