| Name: | Dr. Kevin J. Gross, Optometry, P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Dissolved |
| Date of registration: | 09 Feb 1977 (48 years ago) |
| Date of dissolution: | 20 Dec 2022 |
| Entity Number: | 000-044-385 |
| Register Number: | 000044385 |
| Historical Names: |
Ronald C. Atchley, OD, P.A.
Atchley and Gross, Optometry, P.A. |
| ZIP code: | 35771 |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Mailing Address: | P.O. BOX 290SECTION, AL 35771 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609053990 | 2008-01-29 | 2021-05-17 | PO BOX 290, SECTION, AL, 357710290, US | 24020 JOHN T REID PKWY, SCOTTSBORO, AL, 357682855, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-574-3491 |
| Fax | 2562595113 |
Authorized person
| Name | DR. KEVIN J. GROSS |
| Role | OWNER |
| Phone | 2565743491 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S554-TA-220 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000059775 |
| State | AL |
| Issuer | BCBS |
| Number | 51059775 |
| State | AL |
| Name | Role |
|---|---|
| GROSS, KEVIN J | Member |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1986-11-01 | Name Change | Atchley and Gross, Optometry, P.A. | Dr. Kevin J. Gross, Optometry, P.A. |
| 1984-11-09 | Name Change | Ronald C. Atchley, OD, P.A. | Atchley and Gross, Optometry, P.A. |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
