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General NPI Number Information
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NPI Number | 1326294463
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Entity Type | Organization
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Legal Business Name | JEROME R. GREENBERG, O.D., P.C.
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 1242 E 14TH ST
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City | DES MOINES
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State | IA
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Zip | 50316-2402
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Country | US
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Telephone | 515-263-0295
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Fax | 515-263-0115
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Provider Business Mailing Address
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Address Line | 1242 E 14TH ST
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City | DES MOINES
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State | IA
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Zip | 50316-2402
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Country | US
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Telephone | 515-263-0295
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Fax | 515-263-0115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME RICHARD GREENBERG
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Credential | O.D.
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Telephone | 515-263-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01709
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License Number State | IA
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