1316919665 NPI number — DRS EYE CARE, INC

Table of content: MISS MONICA KAMAL LSA (NPI 1225396757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316919665 NPI number — DRS EYE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS EYE CARE, 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:
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:
1316919665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7323 COLLEGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-750-6600
Provider Business Mailing Address Fax Number:
803-750-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7323 COLLEGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-750-6600
Provider Business Practice Location Address Fax Number:
803-750-6601
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILES
Authorized Official First Name:
VINCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
803-741-7010

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  982 , 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: DA9955 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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