MEDICARE: DR. RUSSELL E GROVE JR. OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OEG000206	PA

General Provider Information

NPI Number	:	1518939313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL E GROVE JR. OD

Provider Business Mailing Address
First Line	:	180 LEADERS HEIGHTS RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4742
Country	:	US
Telephone Number	:	717-747-0533
Fax Number	:	717-747-0532

Provider Business Practice Location Address
First Line	:	180 LEADERS HEIGHTS RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-4742
Country	:	US
Telephone Number	:	717-747-0533
Fax Number	:	717-747-0532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	02/01/2026

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