NPIMap

Individual provider Active NPI

Kevin J Gross, O.D.

  • Optometrist
  • Scottsboro, AL
National Provider Identifier
1861574626
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-554-TA-220 Issued in AL
Practice address
24020 John T Reid Pkwy
Scottsboro, AL 35768-2855
Phone
(256) 574-3491
Fax
(256) 259-5113
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X S-554-TA-220 AL
Low Vision Rehabilitation Optometrist 152WL0500X S-554-TA-220 AL
Pediatric Optometrist 152WP0200X S-554-TA-220 AL
Sports Vision Optometrist 152WS0006X S-554-TA-220 AL
Vision Therapy Optometrist 152WV0400X S-554-TA-220 AL
Occupational Vision Optometrist 152WX0102X S-554-TA-220 AL
Optometrist 152W00000X S-554-TA-220 AL Primary

Addresses

Primary practice location

24020 John T Reid Pkwy
Scottsboro, AL 35768-2855

Mailing address

PO Box 290
Section, AL 35771-0290
Phone (256) 574-3491

Other identifiers 3

IdentifierTypeStateIssuer
000059775MedicaidAL
630711357OtherALTAX ID
51059775OtherALBCBS

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

LicenseStateTypeSpecialty
S-554-TA-220ALMDCorneal and Contact Management Optometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1861574626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290",
            "city": "SECTION",
            "state": "AL",
            "postal_code": "357710290",
            "telephone_number": "256-574-3491",
            "fax_number": "256-259-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24020 JOHN T REID PKWY",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682855",
            "telephone_number": "256-574-3491",
            "fax_number": "256-259-5113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "KEVIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-554-TA-220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000059775",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "630711357",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51059775",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsboro, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.