Provider Demographics
NPI:1609058783
Name:DR. JASON S. BAILEY P.C.
Entity Type:Organization
Organization Name:DR. JASON S. BAILEY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-521-2020
Mailing Address - Street 1:33 KEMMERLIN LANE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2702
Mailing Address - Country:US
Mailing Address - Phone:843-521-2020
Mailing Address - Fax:843-524-7559
Practice Address - Street 1:33 KEMMERLIN LANE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-2702
Practice Address - Country:US
Practice Address - Phone:843-521-2020
Practice Address - Fax:843-524-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00298650OtherRAILROAD MEDICARE
SC5278100001Medicare NSC
SCP00298650OtherRAILROAD MEDICARE