Provider Demographics
NPI:1396044236
Name:JERVEY EYE GROUP, PA
Entity Type:Organization
Organization Name:JERVEY EYE GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-250-6484
Mailing Address - Street 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-458-7956
Mailing Address - Fax:864-458-8390
Practice Address - Street 1:601 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3403
Practice Address - Country:US
Practice Address - Phone:864-458-7956
Practice Address - Fax:864-458-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11002207W00000X
SC8984207W00000X
SC7319207W00000X
SC291207W00000X
SC26913207W00000X
SC24224207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty