Provider Demographics
NPI:1114213584
Name:PIEDMONT FAMILY EYECARE
Entity Type:Organization
Organization Name:PIEDMONT FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DIPASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-489-6871
Mailing Address - Street 1:165 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1268
Mailing Address - Country:US
Mailing Address - Phone:864-489-6871
Mailing Address - Fax:
Practice Address - Street 1:165 WALTON DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1268
Practice Address - Country:US
Practice Address - Phone:864-489-6871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9790Medicaid
SCD11752Medicaid
SCD11752Medicaid