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NPI Code Detail

MEDICARE: DR. GARY HOWARD GREENE O.D.

MEDICARE: DR. GARY HOWARD GREENE 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
1152WC0802XCorneal and Contact Management OptometristAZ0810AZ
2152W00000XOptometristAZ0810AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2AZ0179560OTHERAZBLUE CROSS BLUE SHIELD
3088458OTHERAZAHCCCS

General Provider Information

NPI Number : 1568454155
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY HOWARD GREENE O.D.
Provider Business Mailing Address
First Line : 3943 N WAKEFIELD DR
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86314-6733
Country : US
Telephone Number : 480-296-4646
Fax Number : 480-505-0922
Provider Business Practice Location Address
First Line : 3450 N GLASSFORD HILL RD STE E
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86314-1351
Country : US
Telephone Number : 928-499-3152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 01/28/2026

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