MEDICARE: JASON R GREINER O.D.

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	14396	CA

General Provider Information

NPI Number	:	1417210493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON R GREINER O.D.

Provider Business Mailing Address
First Line	:	11502 LA CIMA DR
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90604-3205
Country	:	US
Telephone Number	:	562-665-6939
Fax Number	:

Provider Business Practice Location Address
First Line	:	4945 YORBA RANCH RD STE E
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-2553
Country	:	US
Telephone Number	:	714-692-2063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	06/24/2012

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