Healthcare Provider Details

I. General information

NPI: 1578557518
Provider Name (Legal Business Name): GIANNETTI & RALSTON EYE CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 OHIO ST
AUGUSTA KS
67010-2153
US

IV. Provider business mailing address

2323 OHIO ST
AUGUSTA KS
67010-2153
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-6341
  • Fax: 316-775-6680
Mailing address:
  • Phone: 316-775-6341
  • Fax: 316-775-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACE P GIANNETTI
Title or Position: DOCTOR
Credential: O.D.
Phone: 316-775-6341