Provider Demographics
NPI:1457081788
Name:HOUSTON, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BYPASS 25 NE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3009
Mailing Address - Country:US
Mailing Address - Phone:864-321-6030
Mailing Address - Fax:864-223-9706
Practice Address - Street 1:300 BYPASS 25 NE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3009
Practice Address - Country:US
Practice Address - Phone:864-321-6030
Practice Address - Fax:864-223-9706
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1314156FX1800X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician