Provider Demographics
NPI:1255493680
Name:BANG, ERIC RILEY (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RILEY
Last Name:BANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2908
Mailing Address - Country:US
Mailing Address - Phone:864-223-1960
Mailing Address - Fax:864-226-1627
Practice Address - Street 1:508 BYPASS 72 NW
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1300
Practice Address - Country:US
Practice Address - Phone:864-223-1960
Practice Address - Fax:864-226-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10450Medicaid
SCD10450Medicaid