Provider Demographics
NPI:1609918028
Name:KRETCH, DANIEL SCOTT (OD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:KRETCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:7631 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5537
Practice Address - Country:US
Practice Address - Phone:440-888-3937
Practice Address - Fax:440-884-7515
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T47754Medicare UPIN
0925170001Medicare ID - Type Unspecified