Provider Demographics
NPI:1538323654
Name:DR. DAVID W. BANG, P.C.
Entity Type:Organization
Organization Name:DR. DAVID W. BANG, P.C.
Other - Org Name:EXPERIENCED EYECARE,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HALE-BANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-764-3030
Mailing Address - Street 1:602 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8675
Mailing Address - Country:US
Mailing Address - Phone:843-764-3030
Mailing Address - Fax:843-851-7448
Practice Address - Street 1:9565 HIGHWAY 78
Practice Address - Street 2:BUILDING 900
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3912
Practice Address - Country:US
Practice Address - Phone:843-764-3030
Practice Address - Fax:843-851-7448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. DAVID W. BANG, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDG8451OtherRR MEDICARE
SC7634Medicare PIN