Provider Demographics
NPI:1407940935
Name:RETO, MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:RETO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2204 HIGHWAY 35 STE 9
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2323
Mailing Address - Country:US
Mailing Address - Phone:732-223-2800
Mailing Address - Fax:732-223-5121
Practice Address - Street 1:2204 HIGHWAY 35 STE 9
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2323
Practice Address - Country:US
Practice Address - Phone:732-671-7300
Practice Address - Fax:732-706-1605
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5917152W00000X
NJ27OA00591700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU76028Medicare UPIN