Provider Demographics
NPI:1720565641
Name:GRETZ, SEAN (OD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:GRETZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:210 MARLBORO AVE STE 31
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2767
Practice Address - Country:US
Practice Address - Phone:410-822-3937
Practice Address - Fax:410-822-2652
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003439152W00000X
DEI3-0001417152W00000X
MDTA3006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG003439OtherLICENSE
DEI3-0001417OtherTHERAPEUTIC OPTOMETRY