Provider Demographics
NPI:1184626301
Name:GREER, GREGORY (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:GREER
Suffix:
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 1:8520 STEILACOOM BLVD SW
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4773
Mailing Address - Country:US
Mailing Address - Phone:253-475-3937
Mailing Address - Fax:855-664-7324
Practice Address - Street 1:4502 S STEELE ST
Practice Address - Street 2:SUITE 304-B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7242
Practice Address - Country:US
Practice Address - Phone:253-472-6465
Practice Address - Fax:253-473-4278
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3834TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029429Medicaid
WA8850749Medicare ID - Type UnspecifiedGROUP BILLING NUMBER
WA2029429Medicaid