Healthcare Provider Details

I. General information

NPI: 1891684551
Provider Name (Legal Business Name): GRACE REWOLINSKI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CLAY ST
JASPER IN
47546-3125
US

IV. Provider business mailing address

1407 ABBY LN
HUNTINGBURG IN
47542-0189
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-6010
  • Fax:
Mailing address:
  • Phone: 765-713-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004598A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: