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General NPI Number Information
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NPI Number | 1629285564
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Entity Type | Organization
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Legal Business Name | RANDY A GROVER O D & ASSOCIATES INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 9300 NW 77TH AVE
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2504
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Country | US
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Telephone | 305-828-8393
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Fax | 305-828-8393
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Provider Business Mailing Address
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Address Line | 801 NE 191ST TER
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City | MIAMI
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State | FL
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Zip | 33179-3976
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Country | US
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Telephone | 786-338-3272
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDY A. GROVER
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Credential | O.D.
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Telephone | 305-828-8393
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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 | OPC 3543
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License Number State | FL
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