Provider Demographics
NPI:1538104963
Name:LANDMARK LEASING INC
Entity Type:Organization
Organization Name:LANDMARK LEASING INC
Other - Org Name:CORLEY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ITS VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:FOLLINE
Authorized Official - Last Name:MIKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-8168
Mailing Address - Street 1:PO BOX 5721
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-799-8168
Mailing Address - Fax:803-799-0854
Practice Address - Street 1:701 BULTMAN DRIVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-773-4723
Practice Address - Fax:803-775-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9862Medicaid
SCDA9862Medicaid
SC0281Medicare PIN