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General NPI Number Information
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NPI Number | 1730312174
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Entity Type | Organization
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Legal Business Name | GROVER VISION, PLLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 7110 S MINGO RD #108
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City | TULSA
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State | OK
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Zip | 74133-3269
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Country | US
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Telephone | 918-252-0438
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Fax | 918-250-0422
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Provider Business Mailing Address
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Address Line | 7110 S MINGO RD #108
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City | TULSA
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State | OK
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Zip | 74133-3269
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Country | US
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Telephone | 918-252-0438
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Fax | 918-250-0422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN DALE GROVER
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Credential | O.D.
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Telephone | 918-252-0438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2527
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License Number State | OK
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