Basic Information
| Provider Information | |||||||||
| NPI: | 1790852291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRECZEK | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 S WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193823141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674080895 | ||||||||
| FaxNumber: | 6103638545 | ||||||||
| Practice Location | |||||||||
| Address1: | 841 E. BALTIMORE PIKE | ||||||||
| Address2: | CHESTER COUNTY OPTICIANS | ||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104445252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG001812 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.