Provider Demographics
NPI:1932386950
Name:TRETTON OPTICAL
Entity type:Organization
Organization Name:TRETTON OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRETTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-522-1040
Mailing Address - Street 1:2801 HUDSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4998
Mailing Address - Country:US
Mailing Address - Phone:410-522-1040
Mailing Address - Fax:410-522-1040
Practice Address - Street 1:2801 HUDSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4998
Practice Address - Country:US
Practice Address - Phone:410-522-1040
Practice Address - Fax:410-522-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30286767332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX998OtherCARE FIRST BC & BS
MD0644760001Medicare PIN
MD0644760001Medicare NSC