Provider Demographics
NPI:1114086204
Name:GREENFIELD, JEFFREY SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:GREENFIELD
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:138 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2806
Practice Address - Country:US
Practice Address - Phone:630-279-2020
Practice Address - Fax:630-279-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705560OtherMEDICARE PROVIDER #
IL0410023089OtherRRMED
IL02222516OtherBCBSIL #
IL363910930OtherTAX ID #
IL363910930OtherTAX ID #
ILU21979Medicare UPIN
IL0545360001Medicare NSC