Provider Demographics
NPI:1336102276
Name:EYE ASSOCIATES OF CAROLINA, PA
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-877-4731
Mailing Address - Street 1:1014 W POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1315
Mailing Address - Country:US
Mailing Address - Phone:864-877-4731
Mailing Address - Fax:864-877-6320
Practice Address - Street 1:1014 W POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1315
Practice Address - Country:US
Practice Address - Phone:864-877-4731
Practice Address - Fax:864-877-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4397085OtherAETNA
SCDA9994Medicaid
SCDC1430OtherRAILROAD MEDICARE
SCDA9994Medicaid
SC=========OtherBCBS
SC0679250001Medicare NSC