Provider Demographics
NPI:1306024823
Name:THOMAS W GREENE, O.D.,P.C.
Entity Type:Organization
Organization Name:THOMAS W GREENE, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-872-5417
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-0031
Mailing Address - Country:US
Mailing Address - Phone:940-872-5417
Mailing Address - Fax:940-872-6754
Practice Address - Street 1:501 E LONDON ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3020
Practice Address - Country:US
Practice Address - Phone:940-872-5417
Practice Address - Fax:940-872-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2610T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219146201Medicaid
TX219146201Medicaid
TX0230690001Medicare NSC
TXTXB107034Medicare PIN