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General NPI Number Information
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NPI Number | 1831277185
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Entity Type | Organization
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Legal Business Name | MALCOLM AND MARTIN GREENE OD PARTNERS
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 31 SPRING ST
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City | WATERTOWN
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State | MA
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Zip | 02472-3473
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Country | US
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Telephone | 617-924-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 31 SPRING ST
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City | WATERTOWN
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State | MA
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Zip | 02472-3473
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Country | US
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Telephone | 617-924-3343
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARTIN J GREENE
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Credential | O.D.
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Telephone | 617-924-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3428
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License Number State | MA
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