Provider Demographics
NPI:1184900078
Name:GREISS, DANA RAE (OD)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RAE
Last Name:GREISS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:RAE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2225 DEFENSE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2468
Mailing Address - Country:US
Mailing Address - Phone:410-721-2500
Mailing Address - Fax:410-721-1308
Practice Address - Street 1:2225 DEFENSE HWY STE C
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2468
Practice Address - Country:US
Practice Address - Phone:410-721-2500
Practice Address - Fax:410-721-1308
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2307152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy