MEDICARE: DR. SCOTT GROSSMAN OD PA

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	OPC4188	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750484564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT GROSSMAN OD PA

Provider Business Mailing Address
First Line	:	18557 W DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-2614
Country	:	US
Telephone Number	:	305-466-0777
Fax Number	:	305-466-0773

Provider Business Practice Location Address
First Line	:	18557 W DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33180-2614
Country	:	US
Telephone Number	:	305-466-0777
Fax Number	:	305-466-0773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/03/2012

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