Provider Demographics
NPI:1710991849
Name:GRONINGER, ELIZABETH A (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GRONINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5680
Mailing Address - Country:US
Mailing Address - Phone:317-839-2368
Mailing Address - Fax:317-839-2338
Practice Address - Street 1:900 EDWARDS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-5680
Practice Address - Country:US
Practice Address - Phone:317-839-2368
Practice Address - Fax:317-839-1267
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002476152W00000X, 152W00000X
IN18002476A152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11478976OtherCAQH
IN000000083757OtherANTHEM
IN410023331Medicare PIN
IN000000083757OtherANTHEM
IN0217050002Medicare NSC
IN11478976OtherCAQH