Provider Demographics
NPI:1508058959
Name:DONELSON EYE ASSOCIATES
Entity Type:Organization
Organization Name:DONELSON EYE ASSOCIATES
Other - Org Name:PIEDMONT EYE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DONELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-987-0034
Mailing Address - Street 1:PO BOX 27169
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-7169
Mailing Address - Country:US
Mailing Address - Phone:864-987-0034
Mailing Address - Fax:864-987-0036
Practice Address - Street 1:1 HALTON GREEN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6606
Practice Address - Country:US
Practice Address - Phone:864-987-0034
Practice Address - Fax:864-987-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
SC10906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC109064Medicaid
SCPC4223Medicaid
SCPC4223Medicaid
SC109064Medicaid
SC2955Medicare PIN