Provider Demographics
NPI:1881752863
Name:GREENWELL, JANNA TERESE (OD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:TERESE
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5492 MEADOWVIEW DR S
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6630
Mailing Address - Country:US
Mailing Address - Phone:406-273-2603
Mailing Address - Fax:
Practice Address - Street 1:3220 NORTHERN PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1338
Practice Address - Country:US
Practice Address - Phone:406-542-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist