Provider Demographics
NPI:1457489080
Name:GROSS, RHONDA S (LDO)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:S
Last Name:GROSS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 FRONT ST
Mailing Address - Street 2:P.O. BOX 706
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-5198
Mailing Address - Country:US
Mailing Address - Phone:423-365-4313
Mailing Address - Fax:423-365-4413
Practice Address - Street 1:473 FRONT ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381
Practice Address - Country:US
Practice Address - Phone:423-365-4313
Practice Address - Fax:423-365-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1737156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5986530001Medicare NSC