Provider Demographics
NPI:1386606861
Name:GREEMAN, NELSON III (OD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:GREEMAN
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2402
Mailing Address - Country:US
Mailing Address - Phone:210-824-4503
Mailing Address - Fax:210-824-2542
Practice Address - Street 1:249 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2402
Practice Address - Country:US
Practice Address - Phone:210-824-4503
Practice Address - Fax:210-824-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2232TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112470301Medicaid
TXT13548Medicare UPIN
TX112470301Medicaid