Provider Demographics
NPI:1326025453
Name:BAILEY, JOEL G (OD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:G
Last Name:BAILEY
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 1:119 LIBRARY HILL LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3893
Mailing Address - Country:US
Mailing Address - Phone:803-359-2110
Mailing Address - Fax:803-359-2314
Practice Address - Street 1:119 LIBRARY HILL LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3893
Practice Address - Country:US
Practice Address - Phone:803-359-2110
Practice Address - Fax:803-359-2314
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07053Medicaid
SCT242599001Medicare PIN
SCT24259Medicare UPIN
SCT242598195Medicare PIN