Basic Information
| Provider Information | |||||||||
| NPI: | 1023236882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRING | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 LAKE SUPERIOR RD APT 108 | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463836742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2242775184 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 422 PERRY ST | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193250404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1446 | SC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2408 | WI | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 18002544A | IN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.