Provider Demographics
NPI:1942794961
Name:GROSS, KATHLEEN (OD, MS, FAAO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 US-93 N
Mailing Address - Street 2:COSTCO EYE CLINIC
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-758-2504
Mailing Address - Fax:
Practice Address - Street 1:862 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4201
Practice Address - Country:US
Practice Address - Phone:347-862-3894
Practice Address - Fax:347-862-3893
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61587545152W00000X
NY008812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty