Provider Demographics
NPI:1366481210
Name:DEVINE EYES INC
Entity Type:Organization
Organization Name:DEVINE EYES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-376-4545
Mailing Address - Street 1:2421 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2405
Mailing Address - Country:US
Mailing Address - Phone:803-376-4545
Mailing Address - Fax:803-254-2324
Practice Address - Street 1:2421 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2405
Practice Address - Country:US
Practice Address - Phone:803-376-4545
Practice Address - Fax:803-254-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC040649753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty