Provider Demographics
NPI:1851477103
Name:GREENWOOD, DARRYL MARSDEN (OD)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:MARSDEN
Last Name:GREENWOOD
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 1:1901 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1231
Mailing Address - Country:US
Mailing Address - Phone:610-373-2300
Mailing Address - Fax:610-373-7014
Practice Address - Street 1:1901 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1231
Practice Address - Country:US
Practice Address - Phone:610-373-2300
Practice Address - Fax:610-373-7014
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006579T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396393OtherNVA/CBC PROVIDER CODE
PAGR552240OtherPBS PROVIDER CODE
PA030058Q3UMedicare ID - Type Unspecified