Provider Demographics
NPI:1659341246
Name:DENAEYER, GREGORY W (OD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:W
Last Name:DENAEYER
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 1:262 NEIL AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2362
Mailing Address - Country:US
Mailing Address - Phone:614-228-4500
Mailing Address - Fax:614-384-2966
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2362
Practice Address - Country:US
Practice Address - Phone:614-228-4500
Practice Address - Fax:614-384-2966
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4921/T1791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307364Medicaid
OHDE0897551Medicare ID - Type Unspecified
U78387Medicare UPIN