Provider Demographics
NPI:1316002801
Name:WEST METRO OPHTHALMOLOGY
Entity type:Organization
Organization Name:WEST METRO OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-546-8422
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:763-546-8422
Mailing Address - Fax:763-546-8114
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-546-8422
Practice Address - Fax:763-546-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCS8149OtherRAILROAD MEDICARE
MN875013100Medicaid
MNCS8149OtherRAILROAD MEDICARE
MN875013100Medicaid