Provider Demographics
NPI:1306835582
Name:ANTLEY, RUFUS BEDFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:BEDFORD
Last Name:ANTLEY
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 1:117 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BATESBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29006-2108
Mailing Address - Country:US
Mailing Address - Phone:803-532-9870
Mailing Address - Fax:803-532-1259
Practice Address - Street 1:117 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-2108
Practice Address - Country:US
Practice Address - Phone:803-532-9870
Practice Address - Fax:803-532-1259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0652760001OtherDMERC
SC570629655-002OtherTRICARE
SCD04332Medicaid
SCT241160281Medicare PIN
SC570629655-002OtherTRICARE