Provider Demographics
NPI:1417575341
Name:GREINER, KAITLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:GREINER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4209
Mailing Address - Country:US
Mailing Address - Phone:843-906-6966
Mailing Address - Fax:
Practice Address - Street 1:735 JOHNNIE DODDS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3060
Practice Address - Country:US
Practice Address - Phone:843-216-2020
Practice Address - Fax:843-410-7018
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist