Provider Demographics
NPI:1457480121
Name:GROVE, JEFFREY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:GROVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049
Mailing Address - Country:US
Mailing Address - Phone:610-967-4600
Mailing Address - Fax:610-967-4600
Practice Address - Street 1:184 MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049
Practice Address - Country:US
Practice Address - Phone:610-967-4600
Practice Address - Fax:610-967-4600
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA005115P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
030554OtherUSHC
030554OtherUSHC