Provider Demographics
NPI:1699859157
Name:GREENBRIER VISION CENTER INC
Entity type:Organization
Organization Name:GREENBRIER VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENGLE-LANEVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-342-5900
Mailing Address - Street 1:300 ASSOCIATION DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1269
Mailing Address - Country:US
Mailing Address - Phone:304-342-5900
Mailing Address - Fax:304-342-6257
Practice Address - Street 1:806 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1527
Practice Address - Country:US
Practice Address - Phone:304-342-5900
Practice Address - Fax:304-342-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005658Medicaid
WV9312131OtherMEDICARE PTAN
WVCH4039OtherRAILROAD MEDICARE PTAN
WV4507080001Medicare NSC