1932179934 NPI number — DR. VAL S DYCHES JR. O.D.

Table of content: DR. VAL S DYCHES JR. O.D. (NPI 1932179934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932179934 NPI number — DR. VAL S DYCHES JR. O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYCHES
Provider First Name:
VAL
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1932179934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 S PENDLETON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29640-3048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-859-3233
Provider Business Mailing Address Fax Number:
864-850-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HALTON RD
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:
29607-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-458-7956
Provider Business Practice Location Address Fax Number:
864-458-8390
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  504 , 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)

  • Identifier: D05046 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4489633 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 3089807002 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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