1407151335 NPI number — RICHARD A. GREENE, O.D., P.A.

Table of content: HALEY ELIZABETH WILKERSON RBT (NPI 1225808397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407151335 NPI number — RICHARD A. GREENE, O.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A. GREENE, O.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407151335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 A1A S
Provider Second Line Business Mailing Address:
SUITE C2
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32080-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-471-8750
Provider Business Mailing Address Fax Number:
904-471-5996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 A1A S
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
SAINT AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32080-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-471-8750
Provider Business Practice Location Address Fax Number:
904-471-5996
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
904-471-8750

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  FL1648 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1114039336 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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