Provider Demographics
NPI:1508178450
Name:GREG PIENTKA, O.D., P.A.
Entity Type:Organization
Organization Name:GREG PIENTKA, O.D., P.A.
Other - Org Name:PALM BEACH EYES OF BOYNTON BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PIENTKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-732-8088
Mailing Address - Street 1:640 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3637
Mailing Address - Country:US
Mailing Address - Phone:561-732-8088
Mailing Address - Fax:561-732-8112
Practice Address - Street 1:640 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3637
Practice Address - Country:US
Practice Address - Phone:561-732-8088
Practice Address - Fax:561-732-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620319100Medicaid
FL620319100Medicaid
FLU70012Medicare UPIN
FLDQ6475Medicare PIN
FL410036539Medicare PIN