Provider Demographics
NPI:1366606873
Name:GROVE, JULIANA (OD)
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:
Last Name:GROVE
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 1:21 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4778
Mailing Address - Country:US
Mailing Address - Phone:219-286-7007
Mailing Address - Fax:219-707-5659
Practice Address - Street 1:21 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4778
Practice Address - Country:US
Practice Address - Phone:219-286-7007
Practice Address - Fax:219-707-5659
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003481A152W00000X
IL046.010308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1518001Medicare PIN
ILP00926554OtherRAILROAD MEDICARE
IL046010308Medicaid