Provider Demographics
NPI:1841286176
Name:GREENBERG, JEROME RICHARD (OD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:RICHARD
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 1:1242 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2402
Mailing Address - Country:US
Mailing Address - Phone:515-263-0295
Mailing Address - Fax:515-263-0115
Practice Address - Street 1:1242 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2402
Practice Address - Country:US
Practice Address - Phone:515-263-0295
Practice Address - Fax:515-263-0115
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1709152W00000X
CA6938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
421168561OtherAUTO OWNERS, PRAIRIE STATES
421168561OtherAMERICARE
81376OtherCOVENTRY ADVANTRA
421168561OtherMEDICARE COMPLETE
421168561OtherADVANTRA FREEDOM
421168561OtherMED BEN
421168561OtherUNITED AMERICAN INSURANCE COMPANY
1709OtherIOWA LICENSE
421168561OtherBRIDGESTONE/FIRESTONE
421168561OtherDEFINITY HEALTH
421168561OtherBANKERS LIFE
421168561OtherCENTRAL RESERVE
421168561OtherEBC (EMPLOYEE BENEFIT CONSULTANTS)
421168561OtherPIRELLI ARMSTRONG
IA0101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
17996OtherWELLMARK BLUE SHIELD
17996OtherFIRST ADMINISTRATORS
17996OtherMUTUAL OF OMAHA
421168561OtherMAILHANDLERS
421168561OtherAMERICAN REPUBLIC
421168561OtherSOUTHERN BENEFIT ADMINISTRATORS INC
421168561OtherPRINCIPAL HEALTHCARE
421168561OtherADVANTICA EYECARE
752838447OtherMIDLANDS CHOICE
0000OtherTRIWEST
421168561OtherUNICARE
421168561OtherGUARANTEE TRUST LIFE INS. CO.
421168561OtherTODAY'S OPTIONS
421168561OtherACCOUNTABLE HEALTH
81376OtherCOVENTRY HEALTHCARE
421168561OtherHUMANA
421168561OtherGLACERS LOCAL #558
421168561OtherAARP
IA0005314Medicaid
410020694OtherRAILROAD MEDICARE
421168561OtherUNITED HEALTHCARE
421168561OtherSECUREHORIZONS
421168561OtherEVERCARE
421168561OtherFEDERATED INSURANCE
6938OtherCALIFORNIA LICENSE
421168561OtherFEDERATED INSURANCE
421168561OtherGLACERS LOCAL #558