Provider Demographics
NPI:1114064664
Name:GREER, ROBERT BRUCE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:GREER
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 1:360 MINOR HALL
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-2020
Mailing Address - Country:US
Mailing Address - Phone:510-642-2020
Mailing Address - Fax:510-643-5109
Practice Address - Street 1:360 MINOR HALL
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2020
Practice Address - Country:US
Practice Address - Phone:510-642-2020
Practice Address - Fax:510-643-5109
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9878TLG152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0098780Medicaid
CAU89277Medicare UPIN
CA0098780Medicare ID - Type Unspecified