1215933510 NPI number — SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA

Table of content: (NPI 1215933510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215933510 NPI number — SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215933510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 DOCTORS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-5608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-269-3333
Provider Business Mailing Address Fax Number:
864-295-1288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 DOCTORS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-5608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-269-3333
Provider Business Practice Location Address Fax Number:
864-295-1288
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
642-220-0737

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1396841599 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 335998 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52668 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053369777 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DA9608 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153549 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548218340 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 6180 . This is a "MEDICARE GROUP NUMBER GREER OFFICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1760431035 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: D17998 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: TL5190 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130735 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1437107836 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1639127046 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: PA6449 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: T48026 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205122975 . This is a "NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1571 . This is a "MEDICARE GROUP GREENVILLE OFFICE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1821439878 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1295886125 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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