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General NPI Number Information
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NPI Number | 1720144975
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Entity Type | Individual
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Provider Name | MARK GREENWALD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 777 BANNOCK ST
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City | DENVER
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State | CO
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Zip | 80204-4597
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Country | US
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Telephone | 303-436-4949
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Fax | 303-602-4560
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Provider Business Mailing Address
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Address Line | 777 BANNOCK ST
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City | DENVER
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State | CO
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Zip | 80204-4597
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Country | US
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Telephone | 303-436-4949
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Fax | 303-602-4560
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036055837
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DR.0070955
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License Number State | CO
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