Provider Demographics
NPI:1508973462
Name:PEE DEE EYE ASSOCIATES PA
Entity Type:Organization
Organization Name:PEE DEE EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-332-7171
Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1956
Mailing Address - Country:US
Mailing Address - Phone:843-332-7171
Mailing Address - Fax:843-332-7802
Practice Address - Street 1:504 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5720
Practice Address - Country:US
Practice Address - Phone:843-332-7171
Practice Address - Fax:843-332-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9759Medicaid
SCD13340Medicaid
SC459665Medicaid
SCD14223Medicaid
SC4582510001Medicare NSC
SCAA06237463Medicare PIN
SCV09891Medicare UPIN
SCT23760Medicare UPIN
SCD13340Medicaid
SCT250347463Medicare PIN
SCAA14847463Medicare PIN
SCT25034Medicare UPIN
SCD14223Medicaid