Provider Demographics
NPI:1487635702
Name:ANDERSON OPTOMETRIC ASSOCIATES
Entity Type:Organization
Organization Name:ANDERSON OPTOMETRIC ASSOCIATES
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:864-847-4440
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-0547
Mailing Address - Country:US
Mailing Address - Phone:864-847-4440
Mailing Address - Fax:864-847-6060
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1912
Practice Address - Country:US
Practice Address - Phone:864-847-4440
Practice Address - Fax:864-847-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9941Medicaid
SC=========002OtherBCBS GROUP NUMBER
SC4528Medicare PIN
SCDA9941Medicaid