Provider Demographics
NPI:1740017235
Name:GROSS, MADISON HAYLEY (OD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:HAYLEY
Last Name:GROSS
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:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0583
Mailing Address - Country:US
Mailing Address - Phone:970-668-2020
Mailing Address - Fax:970-668-0912
Practice Address - Street 1:620B MAIN ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5487
Practice Address - Country:US
Practice Address - Phone:970-668-2020
Practice Address - Fax:970-668-0912
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-011923152W00000X
COOPT.0004100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist