Thomas Dale Greene, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2018021077 Issued in MO

Practice address

1445 Christy Dr Ste a
Jefferson City, MO 65101-2853

Phone

(573) 659-5560

Fax

(573) 659-5561

NPI assigned

Jun 22, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Missouri Eyecare Associates LLCGroup PAC ID 7810372513, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Missouri Eyecare Associates LLC

  • Optometrist
  • Jefferson City, MO
  • NPI 1760117147
  Medicare reassignment Care Compare group NPD
• Central Missouri Vision Center

  • Optometrist
  • Jefferson City, MO
  • NPI 1104924992
  Medicare reassignment NPD
• Central Missouri Dermatology Associates, LLP

  • Dermatology Physician
  • Columbia, MO
  • NPI 1447669932
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1386138303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR STE A",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-659-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR STE A",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-659-5560",
            "fax_number": "573-659-5561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "THOMAS",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-22",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2018021077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRIST LICENSE NUMBER MISSOURI",
            "identifier": "2018021077",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdgreene@centralmoeyecare.eyeclinicdirect.net",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1445 Christy Dr Ste A",
            "city": "Jefferson City",
            "state": "MO",
            "country_code": "US",
            "postal_code": "651012853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kendall Lea Grayson, MA, LPC
• Audrey Susan Green
• Chantel Marie Green, FNP
• Gladious L Green
• Natalie M Green, COTA
• Thomas F Greene, O.D.
• Grey Matters Counseling and Coaching LLC,
• Alice L Griggs, P.T.
• Andrew Scott Grivas Jr.
• Jason Jerome Groene, P.T.

• Optometrist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.