Provider Demographics
NPI:1629285564
Name:RANDY A GROVER O D & ASSOCIATES INC
Entity Type:Organization
Organization Name:RANDY A GROVER O D & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-828-8393
Mailing Address - Street 1:801 NE 191ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3976
Mailing Address - Country:US
Mailing Address - Phone:786-338-3272
Mailing Address - Fax:
Practice Address - Street 1:9300 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2504
Practice Address - Country:US
Practice Address - Phone:305-828-8393
Practice Address - Fax:305-828-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621131300Medicaid
FLK9663Medicare ID - Type UnspecifiedGROUP
FLV08970Medicare UPIN
FLU7219ZMedicare ID - Type UnspecifiedINDIVIDUAL