Provider Demographics
NPI:1780766824
Name:GREENBERG, STUART M (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:M
Last Name:GREENBERG
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:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1132
Mailing Address - Country:US
Mailing Address - Phone:205-208-9955
Mailing Address - Fax:888-561-0756
Practice Address - Street 1:523 GANDY ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1961
Practice Address - Country:US
Practice Address - Phone:205-208-9955
Practice Address - Fax:888-561-0756
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR148TA685152W00000X
MS791152W00000X
GAOPT002359152W00000X
TNOD0000002785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051527186OtherBCBS OF AL
AL009980355Medicaid
MS05027897Medicaid
AL051006214OtherBCBS OF AL
GA781875998CMedicaid
AL009941838Medicaid
TN1510933Medicaid
AL051527187OtherBCBS OF AL
AL051526031OtherBCBS OF AL
MS512I410062Medicare PIN
GA511I410134Medicare PIN
ALP00673654Medicare PIN
AL051527187OtherBCBS OF AL
TNP00693274Medicare PIN
AL051526031OtherBCBS OF AL
AL009980355Medicaid
GA781875998CMedicaid
TN1510933Medicaid
TN3590068Medicare PIN
MSP00673658Medicare PIN