1295047686 NPI number — CAROLINA VISION ASSOCIATES, LLC

Table of content: (NPI 1295047686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295047686 NPI number — CAROLINA VISION ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA VISION ASSOCIATES, LLC
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:
1295047686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 N. DEAN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-583-3125
Provider Business Mailing Address Fax Number:
864-542-1367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 N LIMESTONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAFFNEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29340-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-489-2016
Provider Business Practice Location Address Fax Number:
864-488-1123
Provider Enumeration Date:
07/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WILLARD
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
864-583-3125

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2288 , 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)





Copyright © 2007-2025 www.npivalidator.com