MEDICARE: GRENE VISION GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1285627562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRENE VISION GROUP LLC

Provider Business Mailing Address
First Line	:	1851 N WEBB RD
Second Line	:	ATTN FLR2
City	:	WICHITA
State	:	KS
Zip	:	67206-3413
Country	:	US
Telephone Number	:	316-636-2010
Fax Number	:	316-691-4472

Provider Business Practice Location Address
First Line	:	1851 N WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3413
Country	:	US
Telephone Number	:	316-636-2010
Fax Number	:	316-691-4472

Authorized Official
Title or Position	:	CMO
Name	:	JOSEPH GIRA
Credential	:	MD
Telephone Number	:	316-858-3831

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/24/2023

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Directions to “GRENE VISION GROUP LLC ” Practice Location

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