Provider Demographics
NPI:1942210455
Name:GROSS, WARREN K (OD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:K
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 1:552 ARTHUR GODFREY RD
Mailing Address - Street 2:STE A
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-534-3634
Mailing Address - Fax:305-534-9214
Practice Address - Street 1:552 ARTHUR GODFREY RD
Practice Address - Street 2:STE A
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3510
Practice Address - Country:US
Practice Address - Phone:305-534-3634
Practice Address - Fax:305-534-9214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL173129OtherCHILDREN'S MEDICAL SVC
FL19194Medicare ID - Type Unspecified
FLT54772Medicare UPIN