Provider Demographics
NPI:1760672331
Name:GROVER, ALAN DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DALE
Last Name:GROVER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:7110 S MINGO RD
Mailing Address - Street 2:#108
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3269
Mailing Address - Country:US
Mailing Address - Phone:918-252-0438
Mailing Address - Fax:918-250-0422
Practice Address - Street 1:7110 S MINGO RD
Practice Address - Street 2:#108
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3269
Practice Address - Country:US
Practice Address - Phone:918-252-0438
Practice Address - Fax:918-250-0422
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2017-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK236734701Medicare PIN