Provider Demographics
NPI:1275071631
Name:ROEMMICH EYECARE LLC
Entity Type:Organization
Organization Name:ROEMMICH EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROMMICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-357-1473
Mailing Address - Street 1:205 W BLACKSTOCK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3205
Mailing Address - Country:US
Mailing Address - Phone:864-630-4631
Mailing Address - Fax:843-357-1471
Practice Address - Street 1:15 WOLF DEN DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2985
Practice Address - Country:US
Practice Address - Phone:864-630-4631
Practice Address - Fax:864-576-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10101Medicaid
SCD10101Medicaid