Provider Demographics
NPI:1760672331
Name:GROVER, ALAN DALE (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DALE
Last Name:GROVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3689 N STEELE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5347
Mailing Address - Country:US
Mailing Address - Phone:479-521-2555
Mailing Address - Fax:479-521-6761
Practice Address - Street 1:3689 N STEELE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5347
Practice Address - Country:US
Practice Address - Phone:479-521-2555
Practice Address - Fax:479-521-6761
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2527152W00000X
AR4014207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK236734701Medicare PIN