Provider Demographics
NPI:1871644872
Name:TRETTON, ARNOLD III
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:
Last Name:TRETTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122A WEST RING FACTORY ROAD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5304
Mailing Address - Country:US
Mailing Address - Phone:410-420-7437
Mailing Address - Fax:
Practice Address - Street 1:2801 HUDSON ST.
Practice Address - Street 2:STE.D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4802
Practice Address - Country:US
Practice Address - Phone:410-522-1040
Practice Address - Fax:410-522-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30247729156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX998OtherCARE FIRST BC BS
MDX998OtherCARE FIRST BC BS