1275651382 NPI number — EAST COAST OPTOMETRIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275651382 NPI number — EAST COAST OPTOMETRIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST OPTOMETRIC, INC.
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:
6
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:
1275651382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7539 GARNERS FERRY RD.
Provider Second Line Business Mailing Address:
EAST COAST OPTOMETRIC, INC.
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-779-9313
Provider Business Mailing Address Fax Number:
803-779-9551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 FORUM DR. SUITE 12
Provider Second Line Business Practice Location Address:
H. RUBIN VISION CENTER
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-788-8204
Provider Business Practice Location Address Fax Number:
803-788-8206
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEBBER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
803-788-8204

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1431 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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