Provider Demographics
NPI:1659517175
Name:STUART P. CRESON INC
Entity Type:Organization
Organization Name:STUART P. CRESON INC
Other - Org Name:STUART P. CRESON INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-215-0101
Mailing Address - Street 1:P O BOX 30819
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-215-0101
Mailing Address - Fax:843-215-0113
Practice Address - Street 1:2751 BEAVER RUN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-215-0101
Practice Address - Fax:843-215-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12190Medicaid
SCT301560281Medicare PIN
SCD12190Medicaid