MEDICARE: GARY GREENBERG OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001385	PA

General Provider Information

NPI Number	:	1275666224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY GREENBERG OD PC

Provider Business Mailing Address
First Line	:	1093 N UNION ST
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-2159
Country	:	US
Telephone Number	:	717-944-4031
Fax Number	:	717-944-1890

Provider Business Practice Location Address
First Line	:	1093 N UNION ST
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-2159
Country	:	US
Telephone Number	:	717-944-4031
Fax Number	:	717-944-1890

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GARY A GREENBERG
Credential	:	O.D.
Telephone Number	:	717-944-4031

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	02/28/2008

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