Individual
DR. MICHAEL E GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
210 W 38TH ST, SCOTTSBLUFF, NE 69361-4625
(308) 632-2039
Mailing address
210 W 38TH ST, SCOTTSBLUFF, NE 69361-4625
(308) 632-2039
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
808
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47067174100
—
NE
Enumeration date
08/31/2006
Last updated
08/19/2008
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