Individual
DR. THOMAS DALE GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1445 CHRISTY DR STE A, JEFFERSON CITY, MO 65101-2853
(573) 659-5560
(573) 659-5561
Mailing address
1445 CHRISTY DR STE A, JEFFERSON CITY, MO 65101-2853
(573) 659-5560
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2018021077
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018021077
OPTOMETRIST LICENSE NUMBER MISSOURI
MO
Enumeration date
06/22/2018
Last updated
08/23/2022
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