Provider Demographics
NPI:1760276612
Name:GRAPEVINE VISION LLC
Entity type:Organization
Organization Name:GRAPEVINE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-701-8221
Mailing Address - Street 1:7421 SW BARBUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2887
Mailing Address - Country:US
Mailing Address - Phone:503-343-1603
Mailing Address - Fax:503-343-1604
Practice Address - Street 1:7421 SW BARBUR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2887
Practice Address - Country:US
Practice Address - Phone:503-343-1603
Practice Address - Fax:503-343-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty