Provider Demographics
NPI:1437375482
Name:MILICI FAMILY VISION CTR
Entity Type:Organization
Organization Name:MILICI FAMILY VISION CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:HOPKINS
Authorized Official - Last Name:BOPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-967-8582
Mailing Address - Street 1:877 NORTH EAST MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2041
Mailing Address - Country:US
Mailing Address - Phone:864-967-8582
Mailing Address - Fax:
Practice Address - Street 1:877 NORTH EAST MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2041
Practice Address - Country:US
Practice Address - Phone:864-967-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09300Medicaid
SC360666215OtherBLUE CROSS BLUE SHIELD
SC29160OtherPARTNERS
SC7360Medicare PIN
SC29160OtherPARTNERS