Provider Demographics
NPI:1669857058
Name:POOLE FAMILY EYE CARE OF GAFFNEY LLC
Entity Type:Organization
Organization Name:POOLE FAMILY EYE CARE OF GAFFNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-680-3037
Mailing Address - Street 1:PO BOX 80927
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-0016
Mailing Address - Country:US
Mailing Address - Phone:864-436-1234
Mailing Address - Fax:864-963-7319
Practice Address - Street 1:1502 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1271
Practice Address - Country:US
Practice Address - Phone:864-489-9979
Practice Address - Fax:864-480-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1414152W00000X
SC539152W00000X
SC1731152W00000X
SC1791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty