Provider Demographics
NPI:1467421909
Name:MAHLIE, NANCY (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MAHLIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOUTHERN CENTER CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1533
Mailing Address - Country:US
Mailing Address - Phone:864-633-1053
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTHERN CENTER CT
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1533
Practice Address - Country:US
Practice Address - Phone:864-633-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC582283225OtherBCBS
SCD10548Medicaid
SCU49845Medicare UPIN
SCD10548Medicaid