Provider Demographics
NPI:1174504401
Name:ANDERSON OPTOMETRIC ASSOCIATES
Entity Type:Organization
Organization Name:ANDERSON OPTOMETRIC ASSOCIATES
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:864-847-4440
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0838
Mailing Address - Country:US
Mailing Address - Phone:864-226-6005
Mailing Address - Fax:864-225-1139
Practice Address - Street 1:1220 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4822
Practice Address - Country:US
Practice Address - Phone:864-226-6005
Practice Address - Fax:864-225-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1774Medicaid
SC0622020001Medicare NSC
SC1541Medicare PIN