Provider Demographics
NPI:1891789822
Name:NOAH, GREG M (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:M
Last Name:NOAH
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 1:929 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8683
Mailing Address - Country:US
Mailing Address - Phone:231-947-6246
Mailing Address - Fax:231-947-8864
Practice Address - Street 1:929 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-947-6246
Practice Address - Fax:231-947-8864
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E110240OtherBCBSM
MI4971770Medicaid
MI900E300160OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI900F410030OtherBCBS OF MICHIGAN
MI4971752Medicaid
MIP00397246OtherRAILROAD MEDIICARE
MI4971743Medicaid
MI4971743Medicaid
MI0M92930008Medicare PIN
MI0C86342013Medicare PIN