Provider Demographics
NPI:1972539070
Name:GREENE, THOMAS WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:GREENE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-0031
Mailing Address - Country:US
Mailing Address - Phone:940-872-5417
Mailing Address - Fax:940-872-6754
Practice Address - Street 1:501 E LONDON ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3020
Practice Address - Country:US
Practice Address - Phone:940-872-5417
Practice Address - Fax:940-872-6754
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2610T152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093171903Medicaid
TXE29COtherBLUE CROSS BLUE SHIELD
TXTXB107035Medicare PIN
TX0230690001Medicare NSC
TXE29COtherBLUE CROSS BLUE SHIELD