Provider Demographics
NPI:1528031564
Name:GROMAN, DARRELL EUGENE (OD)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:EUGENE
Last Name:GROMAN
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:PO BOX 209
Mailing Address - Street 2:204 HILTY DR.
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-0209
Mailing Address - Country:US
Mailing Address - Phone:419-384-3275
Mailing Address - Fax:419-384-3285
Practice Address - Street 1:204 HILTY DR.
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877-0209
Practice Address - Country:US
Practice Address - Phone:419-384-3275
Practice Address - Fax:419-384-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2019-03-05
Deactivation Date:2018-02-15
Deactivation Code:
Reactivation Date:2019-03-05
Provider Licenses
StateLicense IDTaxonomies
OH3800/794152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0597420Medicaid
OH0597420Medicaid
OH0319610001Medicare NSC
OHT48311Medicare UPIN