Provider Demographics
NPI:1275666224
Name:GARY GREENBERG OD PC
Entity Type:Organization
Organization Name:GARY GREENBERG OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-944-4031
Mailing Address - Street 1:1093 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2159
Mailing Address - Country:US
Mailing Address - Phone:717-944-4031
Mailing Address - Fax:717-944-1890
Practice Address - Street 1:1093 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-2159
Practice Address - Country:US
Practice Address - Phone:717-944-4031
Practice Address - Fax:717-944-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28522Medicare UPIN
GR96869Medicare ID - Type Unspecified
PA0344250001Medicare NSC