Provider Demographics
NPI:1003095076
Name:WESTMINSTER VISION ASSOCIATES PC
Entity Type:Organization
Organization Name:WESTMINSTER VISION ASSOCIATES PC
Other - Org Name:ONE WAY EYEGLASSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-647-5076
Mailing Address - Street 1:50 E ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2504
Mailing Address - Country:US
Mailing Address - Phone:864-235-8778
Mailing Address - Fax:864-235-8783
Practice Address - Street 1:50 E ANTRIM DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2504
Practice Address - Country:US
Practice Address - Phone:864-235-8778
Practice Address - Fax:864-235-8783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTMINSTER VISION ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9850Medicaid
SCDA9850Medicaid