Healthcare Provider Details

I. General information

NPI: 1306704093
Provider Name (Legal Business Name): GREEN VISION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CENTER ST
SEVILLE OH
44273-8864
US

IV. Provider business mailing address

5702 BUFFHAM RD
SEVILLE OH
44273-9604
US

V. Phone/Fax

Practice location:
  • Phone: 631-356-7970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYNN KADAS
Title or Position: LICENSED OPTICIAN, OWNER
Credential: LDO
Phone: 631-356-7970