NPIMap

Organization Active NPI

Granite City Vision, Inc.

  • Preferred Provider Organization
  • Granite City, IL
National Provider Identifier
1174756902
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
GRANITE CITY VISION, INC.
Practice address
4182 Nameoki Rd.
Granite City, IL 62040-2330
Phone
(618) 876-2438
Fax
(618) 876-2440
NPI assigned
Aug 27, 2009
Last updated
Aug 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Byron W. Wright
Title
Owner
Phone
(618) 339-8951

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X NU Primary
Point of Service 305S00000X NU
Optometrist 152W00000X NU
Contact Lens Fitter 156FC0801X NU
Optician 156FX1800X NU

Addresses

Primary practice location

4182 Nameoki Rd.
Granite City, IL 62040-2330

Mailing address

4182 Nameoki Rd.
Granite City, IL 62040-2330
Phone (618) 876-2438

Other identifiers 1

IdentifierTypeStateIssuer
08533MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100708000266 IL Part B Supplier - Clinic/Group Practice 2860523891 Receives reassigned benefits from 16 practitioners
Practice locations: Granite City, IL

National Provider Directory

National Provider Directory

Locations

4182 Nameoki Rd
Granite City, IL 62040
Phone (618) 876-2438

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1174756902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4182 NAMEOKI RD.",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620402330",
            "telephone_number": "618-876-2438",
            "fax_number": "618-876-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4182 NAMEOKI RD.",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620402330",
            "telephone_number": "618-876-2438",
            "fax_number": "618-876-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY VISION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-339-8951",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08533",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.