Organization
GREEN OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL EDWARD GREEN MD (CHIEF PARTNER)
(615) 452-1602
Entity
Organization
Contact information
Practice address
854 LONE OAK DR, GALLATIN, TN 37066
(615) 452-1602
(615) 452-9643
Mailing address
854 LONE OAK DR, GALLATIN, TN 37066-3694
(615) 452-1602
(615) 452-9643
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0191345
TENNCARE SELECT
—
01
—
021446
BLOCK VISION
—
01
—
3157442
BLUE CROSS BLUE SHIELD
TN
01
—
632
STERLING VISION
—
01
—
905714
BLOCK VISION
—
01
—
OP1903
EYEMED
—
Enumeration date
10/26/2006
Last updated
04/06/2010
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