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General NPI Number Information
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NPI Number | 1831112317
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Entity Type | Individual
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Provider Name | STEPHEN M GROSS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 166 LINDBERG AVE
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City | ATMORE
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State | AL
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Zip | 36502-3206
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Country | US
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Telephone | 251-368-8767
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Fax | 251-368-4565
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Provider Business Mailing Address
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Address Line | 10184 EASTERN SHORE BLVD STE A
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City | SPANISH FORT
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State | AL
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Zip | 36527-5814
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Country | US
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Telephone | 251-368-8767
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Fax | 251-368-4565
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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 | S486TA041
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License Number State | AL
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