Healthcare Provider Details

I. General information

NPI: 1356510531
Provider Name (Legal Business Name): GRENE VISION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 23RD AVE
HUTCHINSON KS
67502-1114
US

IV. Provider business mailing address

1851 N WEBB RD ATTN FLR2
WICHITA KS
67206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7187
  • Fax: 620-663-6447
Mailing address:
  • Phone: 316-636-2010
  • Fax: 316-691-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SHERYL DAVENPORT
Title or Position: INSURANCE DEPARTMENT SUPERVISOR
Credential:
Phone: 316-858-3831