Provider Demographics
NPI:1497184972
Name:DONITA L VADE OD LLC
Entity Type:Organization
Organization Name:DONITA L VADE OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:VADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-644-9014
Mailing Address - Street 1:2123 OLD SPARTANBURG RD
Mailing Address - Street 2:NUM 320
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2704
Mailing Address - Country:US
Mailing Address - Phone:864-644-9014
Mailing Address - Fax:
Practice Address - Street 1:220 N MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2129
Practice Address - Country:US
Practice Address - Phone:864-275-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1669519864OtherINVIDIUAL NPI
SCAA91100281OtherMEDICARE PTAN
SC1669519864OtherINVIDIUAL NPI