Provider Demographics
NPI:1497973978
Name:JEWELL VISION CARE, INC.
Entity Type:Organization
Organization Name:JEWELL VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-283-2020
Mailing Address - Street 1:689 LANCASTER BYP E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-4727
Mailing Address - Country:US
Mailing Address - Phone:803-283-2020
Mailing Address - Fax:803-802-7758
Practice Address - Street 1:689 LANCASTER BYP E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4727
Practice Address - Country:US
Practice Address - Phone:803-283-2020
Practice Address - Fax:803-286-0734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWELL VISION CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9666Medicaid
SC6530OtherRAILROAD MEDICARE
SC6530OtherRAILROAD MEDICARE
SC0639090001Medicare NSC
SCU57521Medicare UPIN
SC6530Medicare PIN