Provider Demographics
NPI:1093750739
Name:RETO, STEVEN JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:RETO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1450 E BOOT RD
Mailing Address - Street 2:BUILDING 700B
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5300
Mailing Address - Country:US
Mailing Address - Phone:610-696-1368
Mailing Address - Fax:610-430-2079
Practice Address - Street 1:1450 E BOOT RD
Practice Address - Street 2:BUILDING 700B
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5300
Practice Address - Country:US
Practice Address - Phone:610-696-1368
Practice Address - Fax:610-430-2079
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0619660001Medicare NSC
PAT30748Medicare UPIN
PA514143JRSMedicare PIN