1902453525 NPI number — SOUTHERN EYE ASSOCIATES OF SC, PA

Table of content: (NPI 1902453525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902453525 NPI number — SOUTHERN EYE ASSOCIATES OF SC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN EYE ASSOCIATES OF SC, PA
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:
1902453525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 DOCTORS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-5608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-269-3333
Provider Business Mailing Address Fax Number:
844-965-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 BOILING SPRINGS RD STE 2400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-4213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-269-3333
Provider Business Practice Location Address Fax Number:
844-965-9275
Provider Enumeration Date:
08/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ZAHND
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
864-269-3333

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; 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