Provider Demographics
NPI:1033190350
Name:ANDERSON OPTOMETRIC ASSOCIATES
Entity Type:Organization
Organization Name:ANDERSON OPTOMETRIC ASSOCIATES
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:864-295-3550
Mailing Address - Street 1:PO BOX 51096
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-2096
Mailing Address - Country:US
Mailing Address - Phone:864-295-3550
Mailing Address - Fax:864-295-3242
Practice Address - Street 1:3529 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7515
Practice Address - Country:US
Practice Address - Phone:864-295-3550
Practice Address - Fax:864-295-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1265413587OtherNPI
SCDA9950Medicaid
1710969969OtherNPI
SC1265413587OtherNPI
SC0622020003Medicare NSC
SC4347Medicare PIN