Provider Demographics
NPI:1295101889
Name:GRECO, LUIGI (OD)
Entity type:Individual
Prefix:
First Name:LUIGI
Middle Name:
Last Name:GRECO
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 1:6101 NEWPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9237
Mailing Address - Country:US
Mailing Address - Phone:269-382-6500
Mailing Address - Fax:269-382-2286
Practice Address - Street 1:6101 NEWPORT RD STE A
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9237
Practice Address - Country:US
Practice Address - Phone:269-382-6500
Practice Address - Fax:269-382-2286
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist