Provider Demographics
NPI:1609830926
Name:GREENBERG, JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
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 1:261 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2521
Mailing Address - Country:US
Mailing Address - Phone:585-325-3070
Mailing Address - Fax:585-325-3073
Practice Address - Street 1:261 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2521
Practice Address - Country:US
Practice Address - Phone:585-325-3070
Practice Address - Fax:585-325-3073
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0734840001Medicare NSC
NYU34118Medicare UPIN
14017BMedicare ID - Type Unspecified