Provider Demographics
NPI:1003078536
Name:JEFFREY M GROVE OD PC
Entity Type:Organization
Organization Name:JEFFREY M GROVE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-967-4600
Mailing Address - Street 1:184 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-4015
Mailing Address - Country:US
Mailing Address - Phone:610-967-4600
Mailing Address - Fax:
Practice Address - Street 1:184 MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-4015
Practice Address - Country:US
Practice Address - Phone:610-967-4600
Practice Address - Fax:610-421-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
038091Medicare PIN