Provider Demographics
NPI:1518105980
Name:DOCTORS EYE CENTER, PA
Entity Type:Organization
Organization Name:DOCTORS EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-798-6189
Mailing Address - Street 1:124 LIMEHOUSE REACH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4402
Mailing Address - Country:US
Mailing Address - Phone:803-798-6189
Mailing Address - Fax:803-798-6189
Practice Address - Street 1:1283 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1973
Practice Address - Country:US
Practice Address - Phone:803-905-8063
Practice Address - Fax:803-905-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU41908OtherUPIN