Provider Demographics
NPI:1548254584
Name:GIANNETTI & RALSTON EYE CARE, P.A.
Entity type:Organization
Organization Name:GIANNETTI & RALSTON EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIANNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-755-0491
Mailing Address - Street 1:301 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-2153
Mailing Address - Country:US
Mailing Address - Phone:316-755-0491
Mailing Address - Fax:316-755-1206
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-2153
Practice Address - Country:US
Practice Address - Phone:316-755-0491
Practice Address - Fax:316-755-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100218990AMedicaid
KS0246600001Medicare NSC
KS017051Medicare ID - Type Unspecified