Larry J Greenhaw, OD
Individual provider Active NPI Optometrist · Oklahoma, OK
NPI 1184758484 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1184758484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 0921 (OK)
- Practice address
- 2501 W Memorial Rd #259a
Oklahoma, OK 73134 - Phone
- (405) 749-0220
- Fax
- (405) 749-0279
- NPI assigned
- Mar 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Midtown Optical PLLC
Practice addresses (Care Compare)
1106 Classen Dr
Oklahoma City, OK 73103-2608
Phone (405) 604-0987
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050913000024 | OK | Practitioner - Optometry | 1153354089 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0921 | OK | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midtown Optical PLLC | Optometrist | Current |
Accepting new patients |
Locations
1106 Classen Dr
Oklahoma City, OK 73103
Phone (405) 604-0987
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0921 | OK | Yes |
Addresses
Primary practice location
2501 W Memorial Rd #259a
Oklahoma, OK 73134
Mailing address
2501 W Memorial Rd #259a
Oklahoma, OK 73134
Phone (405) 749-0220
Other providers in Oklahoma, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.