Provider Demographics
NPI:1821180670
Name:GREEN, DAVID L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:621 S NEW BALLAS RD STE 140A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8254
Mailing Address - Country:US
Mailing Address - Phone:314-251-6430
Mailing Address - Fax:314-251-6065
Practice Address - Street 1:621 S NEW BALLAS RD STE 140A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8254
Practice Address - Country:US
Practice Address - Phone:314-251-6430
Practice Address - Fax:314-251-6065
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003016193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist