Provider Demographics
NPI:1114015732
Name:GREENWAY VISION, INC
Entity Type:Organization
Organization Name:GREENWAY VISION, INC
Other - Org Name:CALHOUN VISION INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-926-2878
Mailing Address - Street 1:3252 WEST LAKE STREET #A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5374
Mailing Address - Country:US
Mailing Address - Phone:612-926-2878
Mailing Address - Fax:612-920-4303
Practice Address - Street 1:3252 WEST LAKE STREET #A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-5374
Practice Address - Country:US
Practice Address - Phone:612-926-2878
Practice Address - Fax:612-920-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4701190001Medicare NSC
MNT39550Medicare UPIN
MNDG6255Medicare PIN