Provider Demographics
NPI:1689781304
Name:PEE DEE EYE ASSOCIATES
Entity Type:Organization
Organization Name:PEE DEE EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-332-7171
Mailing Address - Street 1:603 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-3217
Mailing Address - Country:US
Mailing Address - Phone:843-332-7171
Mailing Address - Fax:843-332-7802
Practice Address - Street 1:603 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-3217
Practice Address - Country:US
Practice Address - Phone:843-332-7171
Practice Address - Fax:843-332-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC459665Medicaid
SCD13340Medicaid
SCDO4546Medicaid
SCT25034Medicare UPIN
SCV01328Medicare UPIN
SCDO4546Medicaid
SC459665Medicaid