Organization
GRANITE CITY VISION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BYRON W. WRIGHT (OWNER)
(618) 339-8951
Entity
Organization
Contact information
Practice address
4182 NAMEOKI RD., GRANITE CITY, IL 62040-2330
(618) 876-2438
(618) 876-2440
Mailing address
4182 NAMEOKI RD., GRANITE CITY, IL 62040-2330
(618) 876-2438
(618) 876-2440
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
156FC0801X
Contact Lens Fitter
—
—
156FX1800X
Optician
—
—
305R00000X
Preferred Provider Organization
Primary
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08533
—
IL
Enumeration date
08/27/2009
Last updated
08/26/2019
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