Provider Demographics
NPI:1083939664
Name:ASHLEY OPTICAL
Entity Type:Organization
Organization Name:ASHLEY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:PEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-766-3768
Mailing Address - Street 1:1637 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6282
Mailing Address - Country:US
Mailing Address - Phone:843-769-0920
Mailing Address - Fax:843-769-4200
Practice Address - Street 1:1637 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6282
Practice Address - Country:US
Practice Address - Phone:843-769-0920
Practice Address - Fax:843-769-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC113683156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0996910001Medicare NSC