Provider Demographics
NPI:1366493413
Name:GREENBERG, MICHAEL H (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:GREENBERG
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 1:8505 TANGLEWOOD SQUARE
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023
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
Practice Address - Country:US
Practice Address - Phone:440-543-5186
Practice Address - Fax:440-543-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3029T143152W00000X
OH28019642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260140Medicaid
OH0459363Medicare PIN
OH0260140Medicaid