Provider Demographics
NPI:1437167558
Name:DILLON EYECARE ASSOCIATES LTD
Entity Type:Organization
Organization Name:DILLON EYECARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MCKETHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-774-2020
Mailing Address - Street 1:300 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2560
Mailing Address - Country:US
Mailing Address - Phone:843-774-2020
Mailing Address - Fax:843-774-3391
Practice Address - Street 1:300 E MONROE ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2560
Practice Address - Country:US
Practice Address - Phone:843-774-2020
Practice Address - Fax:843-774-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9702Medicaid
SCCM4529OtherRAILROAD RETIREMENT MEDIC
SC=========OtherBCBS
SCDA9702Medicaid
SCDA9702Medicaid
SC=========OtherCHAMPUS
SC=========OtherBCBS