Provider Demographics
NPI:1730302993
Name:GROVER, MICHAEL ERIN (LDO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ERIN
Last Name:GROVER
Suffix:
Gender:M
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:PO BOX 71464
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89570-1464
Mailing Address - Country:US
Mailing Address - Phone:775-846-6979
Mailing Address - Fax:
Practice Address - Street 1:4340 VALDEZ WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4938
Practice Address - Country:US
Practice Address - Phone:775-846-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV260156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician