MEDICARE: RHONDA GROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1699933168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHONDA GROSS

Provider Business Mailing Address
First Line	:	473 FRONT ST
Second Line	:	P.O. BOX 706
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	473 FRONT ST
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5198
Country	:	US
Telephone Number	:	423-365-4313
Fax Number	:

Authorized Official
Title or Position	:	OPTICIAN/OWNER
Name	:	RHONDA GROSS
Credential	:
Telephone Number	:	423-365-4313

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	02/13/2019

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