Provider Demographics
NPI:1083803316
Name:CSRA EYE PARTNERS
Entity Type:Organization
Organization Name:CSRA EYE PARTNERS
Other - Org Name:EYE CARE ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPONSELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-641-4646
Mailing Address - Street 1:3553 RICHLAND AVE W
Mailing Address - Street 2:SUITE 136
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3089
Mailing Address - Country:US
Mailing Address - Phone:803-641-4646
Mailing Address - Fax:
Practice Address - Street 1:3553 RICHLAND AVE W
Practice Address - Street 2:SUITE 136
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3089
Practice Address - Country:US
Practice Address - Phone:803-641-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDAG992Medicaid
SC9101Medicare PIN