Active NPI
Grene Vision Group LLC
- Optometrist
- Pittsburg, KS
National Provider Identifier
1821200478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- GRENE VISION GROUP LLC
- Practice address
- 101 West 29TH St
Ste C
Pittsburg, KS 66762 - Phone
- (620) 235-1737
- Fax
- (620) 230-0358
- NPI assigned
- May 4, 2007
- Last updated
- Feb 20, 2008
- Organization subpart
- No
NPPES NPI Registry
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) 858-3831
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | NU | Primary | |
| Ophthalmology Physician | 207W00000X | NU |
Addresses
Primary practice location
101 West 29TH St
Ste C
Pittsburg, KS 66762
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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
-
dba Grene Vision Group
- Optometrist
- Wichita, KS
- NPI 1588115000
O20040407000095
-
dba Grene Vision Group
- Optometrist
- Wichita, KS
- NPI 1598215006
O20040407000095
National Provider Directory
National Provider DirectoryNPI 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": "1821200478",
"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": "101 WEST 29TH ST",
"address_2": "STE C",
"city": "PITTSBURG",
"state": "KS",
"postal_code": "66762",
"telephone_number": "620-235-1737",
"fax_number": "620-230-0358"
}
],
"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": "316-858-3831"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittsburg, 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.