Provider Demographics
NPI:1467634816
Name:FIRST VISION GROUP,LLC
Entity Type:Organization
Organization Name:FIRST VISION GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-679-9900
Mailing Address - Street 1:514 2ND LOOP RD STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2848
Mailing Address - Country:US
Mailing Address - Phone:843-679-9900
Mailing Address - Fax:843-679-9988
Practice Address - Street 1:514 2ND LOOP RD STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2848
Practice Address - Country:US
Practice Address - Phone:843-679-9900
Practice Address - Fax:843-679-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9695Medicaid
SC8232Medicare PIN
SCT10442Medicare UPIN