Provider Demographics
NPI:1326294463
Name:JEROME R. GREENBERG, O.D., P.C.
Entity type:Organization
Organization Name:JEROME R. GREENBERG, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-263-0295
Mailing Address - Street 1:1242 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2402
Mailing Address - Country:US
Mailing Address - Phone:515-263-0295
Mailing Address - Fax:515-263-0115
Practice Address - Street 1:1242 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2402
Practice Address - Country:US
Practice Address - Phone:515-263-0295
Practice Address - Fax:515-263-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01709261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17996OtherFIRST ADMINISTRATORS
IA17996OtherMUTUAL OF OMAHA
IA6155OtherMIDLANDS CHOICE
IA0000OtherTRIWEST
IA81376OtherCOVENTRY HEALTHCARE
IA0005314Medicaid
IA17996OtherWELLMARK BLUE SHIELD
IAIA0101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
IA81376OtherCOVENTRY ADVANTRA
IA410020694OtherRAILROAD MEDICARE
IA81376OtherADVANTRA FREEDOM
IA=========OtherTODAY'S OPTIONS
IA=========OtherGUARANTEE TRUST LIFE INS. CO.
IA=========OtherUNITED AMERICAN INSURANCE COMPANY
IA410020694OtherRAILROAD MEDICARE
IA=========OtherSECUREHORIZONS
IA=========OtherAUTO OWNERS, PRAIRIE STATES
IA=========OtherBANKERS LIFE
IA81376OtherCOVENTRY HEALTHCARE
IA=========OtherHUMANA
IA6155OtherMIDLANDS CHOICE
IA=========OtherFEDERATED INSURANCE
IA=========OtherAMERICARE
IA=========OtherPRINCIPAL HEALTHCARE
IA=========OtherEBC (EMPLOYEE BENEFIT CONSULTANTS)
IA=========OtherUNICARE
IA=========OtherADVANTICA EYECARE
IA=========OtherAMERICAN REPUBLIC
IA=========OtherAARP
IA0005314Medicaid
IA81376OtherADVANTRA FREEDOM
IA=========OtherMEDICARE COMPLETE
IA=========OtherACCOUNTABLE HEALTH
IA81376OtherCOVENTRY ADVANTRA
IA=========OtherSOUTHERN BENEFIT ADMINISTRATORS INC
IA=========OtherBRIDGESTONE/FIRESTONE
IA=========OtherPIRELLI ARMSTRONG
IA=========OtherUNITED HEALTHCARE
IA=========OtherGUARANTEE TRUST LIFE INS. CO.
IA17996Medicare PIN