Provider Demographics
NPI:1003056656
Name:GARY, BETTINA L (OD)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:L
Last Name:GARY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:L
Other - Last Name:LOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7539 GARNERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2627
Mailing Address - Country:US
Mailing Address - Phone:803-779-9313
Mailing Address - Fax:803-779-9551
Practice Address - Street 1:7539 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2627
Practice Address - Country:US
Practice Address - Phone:803-779-9313
Practice Address - Fax:803-779-9551
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist