Provider Demographics
NPI:1679763445
Name:GROSS, AURA (OPTICIAN)
Entity type:Individual
Prefix:
First Name:AURA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5335
Mailing Address - Country:US
Mailing Address - Phone:707-462-1310
Mailing Address - Fax:707-462-1371
Practice Address - Street 1:725 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5335
Practice Address - Country:US
Practice Address - Phone:707-462-1310
Practice Address - Fax:707-462-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL5391156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician