Provider Demographics
NPI:1760478366
Name:GREENE, HENRY ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ARTHUR
Last Name:GREENE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3115 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2652
Mailing Address - Country:US
Mailing Address - Phone:919-493-7456
Mailing Address - Fax:919-493-1718
Practice Address - Street 1:3115 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2652
Practice Address - Country:US
Practice Address - Phone:919-493-7456
Practice Address - Fax:919-493-1718
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1011152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909336Medicaid
T64892Medicare UPIN
NC8909336Medicaid