Provider Demographics
NPI: | 1710107446 |
---|---|
Name: | UPSTATE VISION THERAPY CENTER INC |
Entity Type: | Organization |
Organization Name: | UPSTATE VISION THERAPY CENTER INC |
Other - Org Name: | UPSTATE VISION THERAPY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BILLIE |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | SKINNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 864-288-5882 |
Mailing Address - Street 1: | 3 A WINCHESTER CT |
Mailing Address - Street 2: | |
Mailing Address - City: | MAULDIN |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29662 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-288-5882 |
Mailing Address - Fax: | 864-288-5892 |
Practice Address - Street 1: | 3 A WINCHESTER CT |
Practice Address - Street 2: | |
Practice Address - City: | MAULDIN |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29662 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-288-5882 |
Practice Address - Fax: | 864-288-5892 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-26 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152WV0400X | Eye and Vision Services Providers | Optometrist | Vision Therapy | Group - Single Specialty |