Individual
DR. GREGORY CHAD GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1401 US HIGHWAY 80 W, DEMOPOLIS, AL 36732-4127
(334) 289-0466
(334) 289-5588
Mailing address
1401 US HIGHWAY 80 W, DEMOPOLIS, AL 36732-4127
(334) 289-0466
(334) 289-5588
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S773TA219
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009958385
—
AL
05
—
009958395
—
AL
01
—
51522197
BCBS OF ALABAMA
AL
01
—
51526697
BCBS OF ALABAMA
AL
01
—
5259550001
PALMETTO BUTLER OFFICE
AL
01
—
5259550002
PALMETTO DEMOPOLIS OFFICE
AL
01
—
P00220332
RAILROAD MEDICARE
AL
Enumeration date
11/03/2005
Last updated
03/07/2023
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