Provider Demographics
NPI:1629027651
Name:GROSS, MARGUERITE R (OD)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:R
Last Name:GROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6893
Mailing Address - Country:US
Mailing Address - Phone:919-233-8500
Mailing Address - Fax:919-233-9783
Practice Address - Street 1:229 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6893
Practice Address - Country:US
Practice Address - Phone:919-233-8500
Practice Address - Fax:919-233-9783
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09489OtherBCBSNC PTAN
NC09489OtherBCBSNC PTAN