Healthcare Provider Details

I. General information

NPI: 1114015732
Provider Name (Legal Business Name): GREENWAY VISION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 WEST LAKE STREET #A
MINNEAPOLIS MN
55416-5374
US

IV. Provider business mailing address

3252 WEST LAKE STREET #A
MINNEAPOLIS MN
55416-5374
US

V. Phone/Fax

Practice location:
  • Phone: 612-926-2878
  • Fax: 612-920-4303
Mailing address:
  • Phone: 612-926-2878
  • Fax: 612-920-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: ADAM LAWRENCE
Title or Position: MANAGER
Credential:
Phone: 612-926-2878