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Contact Information

GRANITE CITY VISION, INC.
4182 NAMEOKI RD.
GRANITE CITY, IL62040-2330
 Phone: 618-876-2438
 Fax: 618-876-2440
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Preferred Provider Organization

305R00000X
 

Contact Lens Fitter

156FC0801X
 

Optician

156FX1800X 96[5] Optician
 

Optometrist

152W00000X 41 Optometry
 

Point of Service

305S00000X
Indicates primary specialty

NPI Profile & details for GRANITE CITY VISION, INC.

NPI Number 1174756902
LBN Legal business name GRANITE CITY VISION, INC.
Authorized official BYRON WRIGHT - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/27/2009
Last updated 08/26/2019 - About 7 years ago
Identifiers
IL Medicaid 08533
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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