Provider Demographics
NPI:1821049131
Name:GREENWELL, MARK DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DENNIS
Last Name:GREENWELL
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 1:601 GALVIN RD S
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2249
Mailing Address - Country:US
Mailing Address - Phone:402-293-1849
Mailing Address - Fax:402-293-0385
Practice Address - Street 1:601 GALVIN RD S
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2249
Practice Address - Country:US
Practice Address - Phone:402-293-1849
Practice Address - Fax:402-293-0385
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist