Provider Demographics
NPI:1114109444
Name:DR. MICHAEL H GREENBERG INC
Entity Type:Organization
Organization Name:DR. MICHAEL H GREENBERG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENBERG INC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-543-5186
Mailing Address - Street 1:8505 TANGLEWOOD SQ
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6462
Mailing Address - Country:US
Mailing Address - Phone:440-543-5186
Mailing Address - Fax:440-543-5546
Practice Address - Street 1:8505 TANGLEWOOD SQUARE
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-6462
Practice Address - Country:US
Practice Address - Phone:440-543-5186
Practice Address - Fax:440-543-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH28019642152W00000X
OH3029T143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260140Medicaid
OH9372631Medicare PIN
OH0260140Medicaid