Provider Demographics
NPI:1992776488
Name:GROVE, JAMES E (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:GROVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FIFTH AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-262-9702
Practice Address - Street 1:825 FIFTH AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-262-9700
Practice Address - Fax:717-262-9702
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADA7401OtherRAILROAD MEDICARE
PA0015389300008Medicaid
PA0019400370003Medicaid
P00070100OtherRAILROAD MEDICARE
PA0019400370003Medicaid
P00070100OtherRAILROAD MEDICARE
1303520001Medicare NSC
U33059Medicare UPIN