Provider Demographics
NPI:1669663233
Name:ADVANCED EYE CARE OF THE UPSTATE, PA
Entity Type:Organization
Organization Name:ADVANCED EYE CARE OF THE UPSTATE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-254-6070
Mailing Address - Street 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6301
Mailing Address - Country:US
Mailing Address - Phone:864-254-6070
Mailing Address - Fax:
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6301
Practice Address - Country:US
Practice Address - Phone:864-254-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC46958Medicare UPIN