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General NPI Number Information
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NPI Number | 1568507275
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Entity Type | Individual
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Provider Name | ALICIA R GROVE OD
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 10/30/2011
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Provider Practice Location Address
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Address Line | 106 W BOGGSTOWN RD
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City | SHELBYVILLE
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State | IN
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Zip | 46176-9706
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Country | US
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Telephone | 317-398-9793
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Fax | 317-392-3444
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Provider Business Mailing Address
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Address Line | 2510 COUNTRYSIDE EASTVIEW DR
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City | SHELBYVILLE
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State | IN
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Zip | 46176-3189
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Country | US
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Telephone | 317-512-1176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18003126
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License Number State | IN
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