Active NPI
Gregory John Gruden, O.D.
- Optometrist
- Troy, MI
National Provider Identifier
1407904634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003571
- Practice address
- 2800 W Big Beaver Rd
Ste. N-104
Troy, MI 48084-3206 - Phone
- (248) 649-6766
- Fax
- (248) 649-9513
- NPI assigned
- Jan 5, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003571 | MI | Primary |
Addresses
Primary practice location
2800 W Big Beaver Rd
Ste. N-104
Troy, MI 48084-3206
Mailing address
1720 Northwood Blvd
Royal Oak, MI 48073-3805
Phone (248) 548-6605
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901003571 | MI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxottica of America Inc | Past | Accepting new patients | |
| Luxottica of America Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407904634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 NORTHWOOD BLVD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480733805",
"telephone_number": "248-548-6605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 W BIG BEAVER RD",
"address_2": "STE. N-104",
"city": "TROY",
"state": "MI",
"postal_code": "480843206",
"telephone_number": "248-649-6766",
"fax_number": "248-649-9513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUDEN",
"first_name": "GREGORY",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.