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General NPI Number Information
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NPI Number | 1770543720
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Entity Type | Individual
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Provider Name | DAVID L GROSSWALD O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 1192 DOGWOOD DRIVE
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City | CONYERS
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State | GA
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Zip | 30012-5454
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Country | US
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Telephone | 770-860-1919
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Fax | 770-860-1607
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Provider Business Mailing Address
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Address Line | 1192 DOGWOOD DRIVE
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City | CONYERS
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State | GA
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Zip | 30012-5454
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Country | US
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Telephone | 770-860-1919
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Fax | 770-860-1607
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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 | GA1327
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001327
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License Number State | GA
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