Provider Demographics
NPI:1275535544
Name:GREENE, TODD E (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:GREENE
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 1:1268 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1770
Mailing Address - Country:US
Mailing Address - Phone:413-782-5339
Mailing Address - Fax:413-782-3050
Practice Address - Street 1:160 WEST ST STE J
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416
Practice Address - Country:US
Practice Address - Phone:860-635-6149
Practice Address - Fax:860-632-1401
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002483152W00000X
MA4061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1174068357Medicaid
MA020483OtherCONNECTICARE
MAW16386OtherBLUE CROSS BLUE SHIELD
MA0326381Medicaid
MA34556OtherHEALTH NEW ENGLAND
MACA0822Medicare PIN
MAW16386OtherBLUE CROSS BLUE SHIELD
MA34556OtherHEALTH NEW ENGLAND
CTD400361297Medicare PIN