Provider Demographics
NPI:1952442790
Name:WEST METRO OPHTHALMOLOGY, PA
Entity Type:Organization
Organization Name:WEST METRO OPHTHALMOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-546-8422
Mailing Address - Street 1:107 CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2963
Mailing Address - Country:US
Mailing Address - Phone:763-682-9241
Mailing Address - Fax:763-684-1040
Practice Address - Street 1:107 CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2963
Practice Address - Country:US
Practice Address - Phone:763-682-9241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN875013100Medicaid
MNCS8149OtherRAILROAD MEDICARE
MNCS8149OtherRAILROAD MEDICARE