Provider Demographics
NPI:1790852291
Name:GRECZEK, JUSTIN P (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:GRECZEK
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 1:22 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-3141
Mailing Address - Country:US
Mailing Address - Phone:267-408-0895
Mailing Address - Fax:610-363-8545
Practice Address - Street 1:841 E. BALTIMORE PIKE
Practice Address - Street 2:CHESTER COUNTY OPTICIANS
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-444-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125926Q1AMedicare PIN