Provider Demographics
NPI:1669678140
Name:UNIVERSITY SPECIALTY CLINICS - OPHTHALMOLOGY
Entity Type:Organization
Organization Name:UNIVERSITY SPECIALTY CLINICS - OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-434-6836
Mailing Address - Street 1:3555 HARDEN STREET EXT
Mailing Address - Street 2:15 MEDICAL PARK, SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6894
Mailing Address - Country:US
Mailing Address - Phone:803-545-5022
Mailing Address - Fax:803-256-0977
Practice Address - Street 1:100 PALMETTO HEALTH PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1753
Practice Address - Country:US
Practice Address - Phone:803-545-5500
Practice Address - Fax:803-545-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0368630004OtherMEDICARE DME
SC0368630004OtherMEDICARE DME