Provider Demographics
NPI:1073944278
Name:GROVES, HEATHER (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:GROVES
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 1:2972 RIVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4375
Mailing Address - Country:US
Mailing Address - Phone:304-709-3700
Mailing Address - Fax:
Practice Address - Street 1:2466 E COMMERCIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4011
Practice Address - Country:US
Practice Address - Phone:954-462-1177
Practice Address - Fax:954-492-0352
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4822152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist