Provider Demographics
NPI:1093836124
Name:SANSBURY EYE CENTER
Entity Type:Organization
Organization Name:SANSBURY EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:803-781-2123
Mailing Address - Street 1:7367 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7619
Mailing Address - Country:US
Mailing Address - Phone:803-788-1335
Mailing Address - Fax:803-788-6954
Practice Address - Street 1:7367 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7619
Practice Address - Country:US
Practice Address - Phone:803-788-1335
Practice Address - Fax:803-788-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1811957962Medicare NSC
SC1114987260Medicare NSC
SC0675130000Medicare NSC
0675130001Medicare NSC
SCT-24397Medicare UPIN
SCT-81974Medicare UPIN
SC1235199381Medicare NSC
SC1922067610Medicare NSC
1235199381Medicare NSC
1114987260Medicare NSC
1922067610Medicare NSC
SC5751Medicare PIN
4365Medicare PIN
SC1497714240Medicare NSC
SC0675130004Medicare NSC
SC0675130001Medicare NSC
SC6900Medicare PIN
SC0675130003Medicare NSC
SCU-35567Medicare UPIN
SCU-37657Medicare UPIN