Provider Demographics
NPI:1568814242
Name:GRETZ, DANIELLE CHRISTINA (OD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHRISTINA
Last Name:GRETZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6358
Mailing Address - Country:US
Mailing Address - Phone:520-459-1529
Mailing Address - Fax:
Practice Address - Street 1:2901 N DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2623
Practice Address - Country:US
Practice Address - Phone:919-471-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist