Provider Demographics
NPI:1891144259
Name:GREGORY CHAD GREEN, OD, PC
Entity Type:Organization
Organization Name:GREGORY CHAD GREEN, OD, PC
Other - Org Name:VISUALEYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-289-0466
Mailing Address - Street 1:1401 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4127
Mailing Address - Country:US
Mailing Address - Phone:334-289-0466
Mailing Address - Fax:334-289-5588
Practice Address - Street 1:1490 NORTHBANK PARKWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-861-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-773-TA-219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS-773-TA-219OtherSTATE LICENSE NUMBER