Organization
GROSSNICKLE EYE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW C RALSTIN M.D. (OWNER)
(574) 269-2777
Entity
Organization
Contact information
Practice address
2251 DUBOIS DR, WARSAW, IN 46580-3212
(574) 269-2777
(574) 371-4697
Mailing address
2251 DUBOIS DR, WARSAW, IN 46580-3212
(574) 269-2777
(574) 371-4697
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
50001530A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200018500
—
IN
Enumeration date
06/09/2005
Last updated
03/05/2019
Update your record
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