Organization
GRENE VISION GROUP LLC
Active
Other names
Grene Vision Group
Organization subpart
No
Provider details
NPI number
Authorized official
SHERYL LYNN DAVENPORT (DIRECTOR CORPORATE ACCTS RECEIVABLE)
(316) 858-3831
Entity
Organization
Contact information
Practice address
5231 E CENTRAL AVE, SUITE D, WICHITA, KS 67208-4195
(316) 858-3831
(316) 858-3830
Mailing address
1851 N WEBB RD, WICHITA, KS 67206-3413
(316) 858-3831
(316) 858-3830
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100217500A
—
KS
Enumeration date
10/19/2016
Last updated
10/19/2016
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