Provider Demographics
NPI:1568630960
Name:HIGGINS, NEAL HAMPTON
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:HAMPTON
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 SUMMERS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4922
Mailing Address - Country:US
Mailing Address - Phone:803-536-2970
Mailing Address - Fax:803-534-0266
Practice Address - Street 1:1190 SUMMERS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4922
Practice Address - Country:US
Practice Address - Phone:803-536-2970
Practice Address - Fax:803-534-0266
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC234156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV0234Medicaid