1528130424 NPI number — VISION CARE P A

Table of content: (NPI 1528130424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528130424 NPI number — VISION CARE P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION CARE P A
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:
1528130424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 WEST MAIN STREET
Provider Second Line Business Mailing Address:
PO BOX 251
Provider Business Mailing Address City Name:
DILLON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-774-8112
Provider Business Mailing Address Fax Number:
843-774-8115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29536-3348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-774-8112
Provider Business Practice Location Address Fax Number:
843-774-8115
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-423-7229

Provider Taxonomy Codes

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

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

  • Identifier: DO7892 DA9985 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com