1346289162 NPI number — DR. GRETA I STEINBACH-WALLIS O.D.

Table of content: DR. GRETA I STEINBACH-WALLIS O.D. (NPI 1346289162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346289162 NPI number — DR. GRETA I STEINBACH-WALLIS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEINBACH-WALLIS
Provider First Name:
GRETA
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINBACH
Provider Other First Name:
GRETA
Provider Other Middle Name:
I
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346289162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 SILVERSIDE RD
Provider Second Line Business Mailing Address:
NAAMANS BUILDING
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-4910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-479-3937
Provider Business Mailing Address Fax Number:
302-477-2653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 SILVERSIDE RD
Provider Second Line Business Practice Location Address:
NAAMANS BUILDING
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-479-3937
Provider Business Practice Location Address Fax Number:
302-477-2653
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  I3-0001135 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000061422 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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