Granite City Vision Ctr Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GRANITE CITY VISION CTR INC

Doing business as

Pearle Vision Ctr

Practice address

3717 Nameoki Rd
Ste B
Granite City, IL 62040-3720

Phone

(618) 876-2438

Fax

(618) 876-2440

NPI assigned

Sep 25, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Byron W Wright

Title

Owner

Phone

(618) 876-2438

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pearle Vision Ctr Doing business as

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396845772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3717 NAMEOKI RD",
            "address_2": "STE B",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403720",
            "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": "3717 NAMEOKI RD",
            "address_2": "STE B",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620403720",
            "telephone_number": "618-876-2438",
            "fax_number": "618-876-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY VISION CTR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "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": "618-876-2438"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "212403",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEM GRP",
            "identifier": "K21530",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision Ctr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Granite City, IL
• Providers in Granite City, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.