Provider Demographics
NPI:1679139091
Name:GRUVER, JESSICA (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GRUVER
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 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-372-2848
Practice Address - Street 1:529 SUNFLOWER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2378
Practice Address - Country:US
Practice Address - Phone:814-371-2390
Practice Address - Fax:814-371-9532
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003523152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program