Provider Demographics
NPI:1962253799
Name:GRACE IN VISION
Entity type:Organization
Organization Name:GRACE IN VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-649-1200
Mailing Address - Street 1:1541 S SCATTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5784
Mailing Address - Country:US
Mailing Address - Phone:765-649-1200
Mailing Address - Fax:
Practice Address - Street 1:1541 S SCATTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5784
Practice Address - Country:US
Practice Address - Phone:765-649-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty