Provider Demographics
NPI:1053664581
Name:PRIDE EYECARE PA
Entity Type:Organization
Organization Name:PRIDE EYECARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUNDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-327-2020
Mailing Address - Street 1:1220 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2341
Mailing Address - Country:US
Mailing Address - Phone:803-327-2020
Mailing Address - Fax:803-327-2335
Practice Address - Street 1:1220 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2341
Practice Address - Country:US
Practice Address - Phone:803-327-2020
Practice Address - Fax:803-327-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11351Medicaid
SCU91904Medicare UPIN
SCU919040281Medicare PIN