Provider Demographics
NPI:1578583159
Name:BANKS, ADRIANE E (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANE
Middle Name:E
Last Name:BANKS
Suffix:
Gender:F
Credentials:OD
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 1473
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457-1473
Mailing Address - Country:US
Mailing Address - Phone:843-766-1093
Mailing Address - Fax:843-529-0380
Practice Address - Street 1:4920 CENTRE POINTE DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6927
Practice Address - Country:US
Practice Address - Phone:843-529-0280
Practice Address - Fax:843-529-0380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13162Medicaid
SCD13162Medicaid