Provider Demographics
NPI:1689722555
Name:EYE PHYSICIANS AND SURGEONS OF COLUMBIA
Entity Type:Organization
Organization Name:EYE PHYSICIANS AND SURGEONS OF COLUMBIA
Other - Org Name:EYE PHYSICIANS AND SURGEONS OF COLUMBIA PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-256-7494
Mailing Address - Street 1:601 TAYLOR ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2740
Mailing Address - Country:US
Mailing Address - Phone:803-256-7494
Mailing Address - Fax:803-799-0746
Practice Address - Street 1:601 TAYLOR ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2740
Practice Address - Country:US
Practice Address - Phone:803-256-7494
Practice Address - Fax:803-799-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
SC14309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC148099Medicaid
SC1143660001Medicare NSC
SC148099Medicaid