Provider Demographics
NPI:1427239656
Name:GREENFIELD OPTICAL, P.C.
Entity type:Organization
Organization Name:GREENFIELD OPTICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-834-7710
Mailing Address - Street 1:210 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2706
Practice Address - Country:US
Practice Address - Phone:630-834-7710
Practice Address - Fax:630-834-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008136332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDQ5672OtherRAILROAD MEDICARE
IL02222516OtherBCBSIL #
IL=========OtherTAX ID #
IL=========OtherTAX ID #
ILDQ5672OtherRAILROAD MEDICARE
IL705560Medicare PIN