Provider Demographics
NPI:1760608905
Name:GROSS, REX KARL (OD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:KARL
Last Name:GROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 PARK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-4344
Mailing Address - Country:US
Mailing Address - Phone:706-281-4445
Mailing Address - Fax:706-275-6114
Practice Address - Street 1:2150 E WALNUT AVE
Practice Address - Street 2:STE. 10&11
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4500
Practice Address - Country:US
Practice Address - Phone:706-226-2722
Practice Address - Fax:706-275-6114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU12958Medicare UPIN