Provider Demographics
NPI:1003802687
Name:BANG, DAVID W (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8545
Mailing Address - Country:US
Mailing Address - Phone:843-851-0280
Mailing Address - Fax:843-851-9726
Practice Address - Street 1:9880 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8545
Practice Address - Country:US
Practice Address - Phone:843-851-0280
Practice Address - Fax:843-851-9726
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD08864Medicaid
SCD08864Medicaid