Provider Demographics
NPI:1457639494
Name:ONEWAY EYEGLASSES OF ANDERSON
Entity Type:Organization
Organization Name:ONEWAY EYEGLASSES OF ANDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-647-5076
Mailing Address - Street 1:3300 N MAIN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4128
Mailing Address - Country:US
Mailing Address - Phone:864-222-4009
Mailing Address - Fax:864-222-4030
Practice Address - Street 1:111 RETREAT STREET
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1724
Practice Address - Country:US
Practice Address - Phone:864-647-5076
Practice Address - Fax:864-647-0828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTMINSTER VISION ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-25
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1891770020Medicaid
SCT894115826Medicare Oscar/Certification
SC1891770020Medicaid