Provider Demographics
NPI:1639130305
Name:BLUE RIDGE EYE CENTER, P.A.
Entity Type:Organization
Organization Name:BLUE RIDGE EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-985-1110
Mailing Address - Street 1:530 BY PASS 123
Mailing Address - Street 2:SUITE C
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0844
Mailing Address - Country:US
Mailing Address - Phone:864-985-1110
Mailing Address - Fax:864-985-1410
Practice Address - Street 1:530 BY PASS 123
Practice Address - Street 2:SUITE C
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0844
Practice Address - Country:US
Practice Address - Phone:864-985-1110
Practice Address - Fax:864-985-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
SC5655540001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8446Medicare PIN
SC5655540001Medicare NSC