Provider Demographics
NPI:1689682510
Name:ORANGEBURG OPTICIANS
Entity Type:Organization
Organization Name:ORANGEBURG OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-534-0266
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:1190 SUMMERS AVE NE
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1226
Mailing Address - Country:US
Mailing Address - Phone:803-536-2970
Mailing Address - Fax:803-584-0904
Practice Address - Street 1:1190 SUMMERS AVE NE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-536-2970
Practice Address - Fax:803-534-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV0234Medicaid
SCDV0234Medicaid