Basic Information
| Provider Information | |||||||||
| NPI: | 1265786925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERONICA M RALICK OD & ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7359 WINCHESTER LN | ||||||||
| Address2: | |||||||||
| City: | SCHERERVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463751776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193225205 | ||||||||
| FaxNumber: | 2193225233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 US HIGHWAY 41 | ||||||||
| Address2: | |||||||||
| City: | SCHERERVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463751353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193225205 | ||||||||
| FaxNumber: | 2193225233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | RALICK | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7737505222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18003290A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.