Provider Demographics
NPI:1477692820
Name:NINI S PATHEJA
Entity Type:Organization
Organization Name:NINI S PATHEJA
Other - Org Name:AIKEN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT CCS
Authorized Official - Phone:803-642-6060
Mailing Address - Street 1:110 PEPPER HILL WAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2818
Mailing Address - Country:US
Mailing Address - Phone:803-642-6060
Mailing Address - Fax:803-642-0754
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2818
Practice Address - Country:US
Practice Address - Phone:803-642-6060
Practice Address - Fax:803-642-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21946332B00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3927440001OtherMEDICARE SUPPLIER PROVIDER #
SCDMO344Medicaid
SCDMO344Medicaid