Provider Demographics
NPI:1003851775
Name:EYE ASSOCIATES OF WINNSBORO
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF WINNSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-635-6496
Mailing Address - Street 1:1007 KINCAID BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7113
Mailing Address - Country:US
Mailing Address - Phone:803-635-6496
Mailing Address - Fax:803-635-6932
Practice Address - Street 1:1007 KINCAID BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7113
Practice Address - Country:US
Practice Address - Phone:803-635-6496
Practice Address - Fax:803-635-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9990Medicaid
SCDA9990Medicaid
SCDR8766Medicare PIN
SC6917550001Medicare NSC
SC9001Medicare PIN
SCP00973850Medicare PIN