NPIMap

Organization Active NPI

Grene Vision Group LLC

  • Optometrist
  • Lyons, KS
National Provider Identifier
1649482282
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GRENE VISION GROUP LLC
Practice address
111 West First
Lyons, KS 67554
Phone
(620) 257-2600
Fax
(620) 257-5033
NPI assigned
May 4, 2007
Last updated
Feb 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Sheryl Davenport
Title
Insurance Department Supervisor
Phone
(316) 691-3955

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary
Ophthalmology Physician 207W00000X

Addresses

Primary practice location

111 West First
Lyons, KS 67554

Mailing address

1851 N Webb Rd
Attn FLR2
Wichita, KS 67206-3413
Phone (316) 636-2010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407000095 KS Part B Supplier - Clinic/Group Practice 1254324023 Receives reassigned benefits from 45 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wellington, KS; Wichita, KS; Winfield, KS; Yates Center, KS; El Dorado, KS; Neodesha, KS; Lyons, KS; Hutchinson, KS…

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

National Provider Directory

Locations

111 W 1st St
Lyons, KS 67554
Phone (620) 257-2600

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1649482282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 N WEBB RD",
            "address_2": "ATTN FLR2",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063413",
            "telephone_number": "316-636-2010",
            "fax_number": "316-691-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WEST FIRST",
            "city": "LYONS",
            "state": "KS",
            "postal_code": "67554",
            "telephone_number": "620-257-2600",
            "fax_number": "620-257-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENE VISION GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "INSURANCE DEPARTMENT SUPERVISOR",
        "authorized_official_telephone_number": "316-691-3955"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyons, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.