Provider Demographics
NPI:1922012814
Name:GROSTICK, DARCY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:LYNN
Last Name:GROSTICK
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 1:4600 MUELLER BLVD
Mailing Address - Street 2:APT #4029
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3186
Mailing Address - Country:US
Mailing Address - Phone:312-593-4361
Mailing Address - Fax:
Practice Address - Street 1:4600 MUELLER BLVD
Practice Address - Street 2:APT #4029
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3186
Practice Address - Country:US
Practice Address - Phone:312-593-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009870152W00000X
TX8526T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362492289OtherTAX ID
IL1636706OtherBCBS
IL7235044OtherAETNA
IL211019OtherMEDICARE GROUP
IL210209OtherMEDICARE GROUP
IL046009870Medicaid
IL0757500002Medicare NSC
ILR02346Medicare PIN
IL211019OtherMEDICARE GROUP
ILR02347Medicare PIN
IL1636706OtherBCBS