Provider Demographics
NPI:1073646089
Name:DAVID G GROSS DO, PC
Entity Type:Organization
Organization Name:DAVID G GROSS DO, PC
Other - Org Name:DEEN-GROSS EYE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-769-8989
Mailing Address - Street 1:303 W 89TH AVE
Mailing Address - Street 2:SUITE E4
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6294
Mailing Address - Country:US
Mailing Address - Phone:219-769-8989
Mailing Address - Fax:219-756-6389
Practice Address - Street 1:303 W 89TH AVE
Practice Address - Street 2:SUITE E4
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6294
Practice Address - Country:US
Practice Address - Phone:219-769-8989
Practice Address - Fax:219-756-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000105018OtherANTHEM
876880Medicare ID - Type Unspecified
IN000000105018OtherANTHEM