Provider Demographics
NPI:1710130471
Name:GEORGE'S CLEARVISION
Entity Type:Organization
Organization Name:GEORGE'S CLEARVISION
Other - Org Name:CLEAR VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:843-549-2565
Mailing Address - Street 1:1009 BELLS HWY
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488
Mailing Address - Country:US
Mailing Address - Phone:843-549-2565
Mailing Address - Fax:843-549-1892
Practice Address - Street 1:1009 BELLS HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-549-2565
Practice Address - Fax:843-549-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV1837Medicaid
SC0783590001Medicare NSC