Provider Demographics
NPI:1659571297
Name:ELGIN FAMILY EYE CARE, LLC
Entity Type:Organization
Organization Name:ELGIN FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:803-438-8848
Mailing Address - Street 1:879 WHITE POND RD STE C
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9828
Mailing Address - Country:US
Mailing Address - Phone:803-438-8848
Mailing Address - Fax:803-438-1857
Practice Address - Street 1:879 WHITE POND RD STE C
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-9828
Practice Address - Country:US
Practice Address - Phone:803-438-8848
Practice Address - Fax:803-438-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC866156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty