Provider Demographics
NPI:1861574626
Name:GROSS, KEVIN J (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:GROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771-0290
Mailing Address - Country:US
Mailing Address - Phone:256-574-3491
Mailing Address - Fax:256-259-5113
Practice Address - Street 1:24020 JOHN T REID PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2855
Practice Address - Country:US
Practice Address - Phone:256-574-3491
Practice Address - Fax:256-259-5113
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-554-TA-220152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059775Medicaid
AL630711357OtherTAX ID
AL51059775OtherBCBS