Provider Demographics
NPI:1457540692
Name:HENRY A GREENE OD PA
Entity Type:Organization
Organization Name:HENRY A GREENE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-493-7456
Mailing Address - Street 1:3115 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2652
Mailing Address - Country:US
Mailing Address - Phone:919-493-7456
Mailing Address - Fax:919-493-1718
Practice Address - Street 1:3115 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2652
Practice Address - Country:US
Practice Address - Phone:919-493-7456
Practice Address - Fax:919-493-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909336Medicaid
T64892Medicare UPIN
NC8909336Medicaid