Provider Demographics
NPI:1407151335
Name:RICHARD A. GREENE, O.D., P.A.
Entity Type:Organization
Organization Name:RICHARD A. GREENE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-471-8750
Mailing Address - Street 1:2225 A1A S
Mailing Address - Street 2:SUITE C2
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-2916
Mailing Address - Country:US
Mailing Address - Phone:904-471-8750
Mailing Address - Fax:904-471-5996
Practice Address - Street 1:2225 A1A S
Practice Address - Street 2:SUITE C2
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-2916
Practice Address - Country:US
Practice Address - Phone:904-471-8750
Practice Address - Fax:904-471-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114039336OtherINDIVIDUAL NPI
FL1114039336OtherINDIVIDUAL NPI