Healthcare Provider Details

I. General information

NPI: 1982595898
Provider Name (Legal Business Name): MATTHEW JAMES GRAESSLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N EASTERN AVE
CONNERSVILLE IN
47331-1935
US

IV. Provider business mailing address

7520 GLADSTONE DR UNIT 102
NAPERVILLE IL
60565-1125
US

V. Phone/Fax

Practice location:
  • Phone: 765-233-4621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: