Provider Demographics
NPI:1902850308
Name:GREGORY T GREER OD & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:GREGORY T GREER OD & ASSOCIATES, PLLC
Other - Org Name:SOUTH SOUND EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-475-3937
Mailing Address - Street 1:8520 STEILACOOM BLVD SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4773
Mailing Address - Country:US
Mailing Address - Phone:253-475-3937
Mailing Address - Fax:855-664-7324
Practice Address - Street 1:8520 STEILACOOM BLVD SW
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4773
Practice Address - Country:US
Practice Address - Phone:253-475-3937
Practice Address - Fax:855-664-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3834TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029429Medicaid
WA2029429Medicaid