Provider Demographics
NPI:1669668018
Name:FLORENCE VISION CENTER PA
Entity Type:Organization
Organization Name:FLORENCE VISION CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-662-3912
Mailing Address - Street 1:1911 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6122
Mailing Address - Country:US
Mailing Address - Phone:843-662-3912
Mailing Address - Fax:843-667-4550
Practice Address - Street 1:1911 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6122
Practice Address - Country:US
Practice Address - Phone:843-662-3912
Practice Address - Fax:843-667-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC00657332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1275558322OtherRONALD C BROWN SR NPI
SCD06571Medicaid
TN0875650001Medicare NSC
SCD06571Medicaid