| Organization Name: | GREENBRIER PHYSICIANS, INC. OPTICAL SHOP |
| NPI Number: | 1861629917 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN D. TROUT (CLINIC ADMINISTRATOR) |
| Mailing Address: | 200 Maplewood Ave Ronceverte |
| State: | WV US |
| Postal Code: | 249701334 |
| Phone Number: | 3046471147 |
| Fax Number: | 3046473006 |
| NPI Enumeration Date: | 06/16/2009 |
| NPI Last Update Date: | 06/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156F00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A broad category grouping different kinds of technologists and technicians. See individual definitions. |