Provider Demographics
NPI:1477736080
Name:HARE, GREG A (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:HARE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 W SIMS WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2234
Mailing Address - Country:US
Mailing Address - Phone:360-379-6477
Mailing Address - Fax:360-379-6478
Practice Address - Street 1:2500 W SIMS WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2234
Practice Address - Country:US
Practice Address - Phone:360-379-6477
Practice Address - Fax:360-379-6478
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1715TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007880Medicaid
WAP00096244OtherRAILROAD MEDICARE
WA6010488OtherREGENCE
WA1217120001Medicare NSC
WAP00096244OtherRAILROAD MEDICARE