Individual
JEROME RICHARD GREENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1242 E 14TH ST, DES MOINES, IA 50316-2402
(515) 263-0295
(515) 263-0115
Mailing address
1242 E 14TH ST, DES MOINES, IA 50316-2402
(515) 263-0295
(515) 263-0115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1709
IA
152W00000X
Optometrist
6938
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
TRIWEST
—
05
—
0005314
—
IA
01
—
1709
IOWA LICENSE
—
01
—
17996
WELLMARK BLUE SHIELD
—
01
—
410020694
RAILROAD MEDICARE
—
01
—
421168561
AUTO OWNERS, PRAIRIE STATES
—
01
—
6938
CALIFORNIA LICENSE
—
01
—
752838447
MIDLANDS CHOICE
—
01
—
81376
COVENTRY ADVANTRA
—
01
—
IA0101
UNITED HEALTHCARE OF THE RIVER VALLEY
—
Enumeration date
09/22/2005
Last updated
10/27/2008
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