Provider Demographics
NPI:1548226822
Name:DRAISIN, NEIL WILLIAM (OD,FCOVD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WILLIAM
Last Name:DRAISIN
Suffix:
Gender:M
Credentials:OD,FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80817
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0817
Mailing Address - Country:US
Mailing Address - Phone:843-556-2020
Mailing Address - Fax:843-763-3937
Practice Address - Street 1:1470 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4707
Practice Address - Country:US
Practice Address - Phone:843-556-2020
Practice Address - Fax:843-763-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC503152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05037Medicaid
SCP00081761Medicare ID - Type UnspecifiedRAILROAD
SCD05037Medicaid
SCT24567Medicare UPIN