Provider Demographics
NPI:1043282452
Name:EYE & CONTACT LENS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:EYE & CONTACT LENS ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-882-3338
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0249
Mailing Address - Country:US
Mailing Address - Phone:864-882-3338
Mailing Address - Fax:864-885-0349
Practice Address - Street 1:807 BY PASS 123
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4759
Practice Address - Country:US
Practice Address - Phone:864-882-3338
Practice Address - Fax:864-885-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9875Medicaid
SC1169710002Medicare NSC
SCDA9875Medicaid