Provider Demographics
NPI:1003977349
Name:GREENBERG, JASON H (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:H
Last Name:GREENBERG
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:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-0357
Mailing Address - Country:US
Mailing Address - Phone:773-426-3055
Mailing Address - Fax:773-348-9538
Practice Address - Street 1:248 E GLADYS AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1928
Practice Address - Country:US
Practice Address - Phone:630-630-9144
Practice Address - Fax:773-346-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMG0889139OtherDEA
ILMO0889139OtherDEA
ILU93853Medicare UPIN