Provider Demographics
NPI:1447785423
Name:SANSBURY VISION SERVICES LLC
Entity Type:Organization
Organization Name:SANSBURY VISION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:803-781-2123
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1107
Mailing Address - Country:US
Mailing Address - Phone:803-781-2123
Mailing Address - Fax:803-749-0183
Practice Address - Street 1:121 LUCY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7835
Practice Address - Country:US
Practice Address - Phone:803-217-2550
Practice Address - Fax:803-217-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty