Healthcare Provider Details

I. General information

NPI: 1942127717
Provider Name (Legal Business Name): CALEB WAYNE GROSS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 CAMPBELLSVILLE RD
COLUMBIA KY
42728-2263
US

IV. Provider business mailing address

1463 CAMPBELLSVILLE RD
COLUMBIA KY
42728-2263
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-6043
  • Fax: 270-384-0672
Mailing address:
  • Phone: 270-384-6043
  • Fax: 270-384-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2474DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: