Provider Demographics
NPI:1346289162
Name:STEINBACH-WALLIS, GRETA I (OD)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:I
Last Name:STEINBACH-WALLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRETA
Other - Middle Name:I
Other - Last Name:STEINBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3501 SILVERSIDE RD
Mailing Address - Street 2:NAAMANS BUILDING
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4910
Mailing Address - Country:US
Mailing Address - Phone:302-479-3937
Mailing Address - Fax:302-477-2653
Practice Address - Street 1:3501 SILVERSIDE RD
Practice Address - Street 2:NAAMANS BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4910
Practice Address - Country:US
Practice Address - Phone:302-479-3937
Practice Address - Fax:302-477-2653
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000061422Medicaid
DET26950Medicare UPIN
DE123072Medicare ID - Type Unspecified