MEDICARE: DR. DONOVAN GEORGE GREEN 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	435	NM

General Provider Information

NPI Number	:	1750362117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONOVAN GEORGE GREEN O.D.

Provider Business Mailing Address
First Line	:	2618 DOUGLAS FIR
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2546
Country	:	US
Telephone Number	:	210-709-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 E. CENTRAL EXPRESSWAY
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76543
Country	:	US
Telephone Number	:	254-690-4733
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/28/2023

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