Individual
GRECHIA STANLEY DEVITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
411 COMMERCE DR NE, COLUMBIA, SC 29223-4583
(803) 254-9381
Mailing address
198 SIERRAS LOOP, ST AUGUSTINE, FL 32086-9046
(803) 254-9381
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
000682
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000682
LICENSED DISPENSING OPTICIAN
GA
Enumeration date
07/10/2017
Last updated
07/10/2017
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