Provider Demographics
NPI:1215959051
Name:GRECO, JAMES L JR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:GRECO
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4710 N HABANA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7161
Mailing Address - Country:US
Mailing Address - Phone:813-879-0324
Mailing Address - Fax:813-870-3954
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-879-0324
Practice Address - Fax:813-870-3954
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084338500Medicaid
FL0492800001Medicare NSC
FL084338500Medicaid
T83992FLMedicare UPIN