Gregory Chad Green OD
Organization Active NPI Optometrist · Demopolis, AL
NPI 1720152739 · NPPES record last updated Jul 14, 2022
Key facts
- NPI
- 1720152739
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- S-773-TA-219 (AL)
- Legal business name
- GREGORY CHAD GREEN OD
- Practice address
- 1401 US Highway 80 West
Demopolis, AL 36732-4127 - Phone
- (334) 289-0466
- Fax
- (334) 289-5588
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. G Chad Green, O.D.
- Title
- Owner
- Phone
- (334) 289-0466
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 2
Practitioners 3
-
Gregory Chad Green, O.D.
-
Taylor Phillips, OD, MBA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D1083392 | Green Family Eye Care | Certificate of waiver | Apr 30, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040728001167 | AL | Part B Supplier - Clinic/Group Practice | 5597735415 |
Receives reassigned benefits from 3 practitioners 2 other NPIs on this enrollment Practice locations: Tuscaloosa, AL; Demopolis, AL; Fayette, AL |
National Provider Directory
- Tax ID family
- Gregory Chad Green OD
Locations
1043 US Highway 80 W
Demopolis, AL 36732
Phone (334) 289-0466
1490 N Bank Pkwy
Ste 120
Tuscaloosa, AL 35406
Phone (205) 861-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | S-773-TA-219 | AL | Yes |
Addresses
Primary practice location
1401 US Highway 80 West
Demopolis, AL 36732-4127
Mailing address
1401 US Highway 80 West
Demopolis, AL 36732-4127
Phone (334) 289-0466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529920020 | Medicaid | AL | |
| 01D1083392 | Other | AL | CLIA ID NUMBER |
Other names
- Green Family Eye Care
Other providers in Demopolis, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2022. 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.
- 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.