Provider Demographics
NPI:1831277185
Name:MALCOLM AND MARTIN GREENE OD PARTNERS
Entity type:Organization
Organization Name:MALCOLM AND MARTIN GREENE OD PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-924-3343
Mailing Address - Street 1:31 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3473
Mailing Address - Country:US
Mailing Address - Phone:617-924-3343
Mailing Address - Fax:
Practice Address - Street 1:31 SPRING ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3473
Practice Address - Country:US
Practice Address - Phone:617-924-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9778349Medicaid
MA9778349Medicaid
0267380001Medicare NSC