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General NPI Number Information
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NPI Number | 1003930868
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Entity Type | Organization
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Legal Business Name | SCOTT GROSSMAN OD PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 18557 WEST DIXIE HIGHWAY
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-466-0777
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Fax | 305-466-0773
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Provider Business Mailing Address
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Address Line | 18557 W DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33180-2614
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Country | US
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Telephone | 305-466-0777
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Fax | 305-466-0773
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | SCOTT GROSSMAN
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Credential | OD PA
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Telephone | 305-466-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4188
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License Number State | FL
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