MEDICARE: GREENMAN EYE ASSOCIATES PLLC

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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801853270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENMAN EYE ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	2801 RANDOLPH RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1047
Country	:	US
Telephone Number	:	704-375-2101
Fax Number	:	704-375-2107

Provider Business Practice Location Address
First Line	:	2801 RANDOLPH RD
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1047
Country	:	US
Telephone Number	:	704-375-2101
Fax Number	:	704-375-2107

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	DR. MAXWELL GREENMAN
Credential	:
Telephone Number	:	704-375-2101

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	04/14/2014

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