Healthcare Provider Details

I. General information

NPI: 1699859157
Provider Name (Legal Business Name): GREENBRIER VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GREENBRIER ST
CHARLESTON WV
25311-1527
US

IV. Provider business mailing address

300 ASSOCIATION DR
CHARLESTON WV
25311-1269
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-5900
  • Fax: 304-342-6257
Mailing address:
  • Phone: 304-342-5900
  • Fax: 304-342-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LYNN E. ENGLE-LANEVE
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 304-342-5900