Provider Demographics
NPI:1568404044
Name:EYE ASSOCIATES OF LITTLE RIVER, LLC
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF LITTLE RIVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-333-5435
Mailing Address - Street 1:4000 HIGHWAY 9 E
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7833
Mailing Address - Country:US
Mailing Address - Phone:843-390-0058
Mailing Address - Fax:843-390-0999
Practice Address - Street 1:4000 HIGHWAY 9 E
Practice Address - Street 2:SUITE 260
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7833
Practice Address - Country:US
Practice Address - Phone:843-390-0058
Practice Address - Fax:843-390-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1408152W00000X
SC1409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9678Medicaid
SCDN6087OtherRAILROAD MEDICARE
SCDN6087OtherRAILROAD MEDICARE
SC8517Medicare PIN