Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5180 | OH |
NPI | 1013092428 |
---|---|
Provider Name | Dr. James David Grove |
First Address | Urbana, OH 43078-1605 |
Second Address | Urbana, OH 43078-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 25/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2237476 | (05) | OH |
U87976 | (02) | OH |