Provider Demographics
NPI:1659315802
Name:AIKEN OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:AIKEN OPHTHALMOLOGY PC
Other - Org Name:AIKEN OPHTHALMOLOGY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KROK
Authorized Official - Suffix:
Authorized Official - Credentials:COE, ST
Authorized Official - Phone:803-642-6060
Mailing Address - Street 1:110 PEPPER HILL WAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2818
Mailing Address - Country:US
Mailing Address - Phone:803-642-6060
Mailing Address - Fax:803-642-0754
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2818
Practice Address - Country:US
Practice Address - Phone:803-642-6060
Practice Address - Fax:803-642-0754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIKEN OPHTHALMOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21946261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2963Medicaid
SCCH7684OtherRAILROAD MEDICARE
SCGP2963Medicaid