Healthcare Provider Details

I. General information

NPI: 1073646089
Provider Name (Legal Business Name): DAVID G GROSS DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

IV. Provider business mailing address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8989
  • Fax: 219-756-6389
Mailing address:
  • Phone: 219-769-8989
  • Fax: 219-756-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID G GROSS
Title or Position: OWNER
Credential: D.O.
Phone: 219-769-8989