Provider Demographics
NPI:1710174297
Name:DR. DAVID W. BANG, P.C.
Entity Type:Organization
Organization Name:DR. DAVID W. BANG, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-824-3937
Mailing Address - Street 1:9565 HIGHWAY 78
Mailing Address - Street 2:BLDG 900
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3912
Mailing Address - Country:US
Mailing Address - Phone:843-824-3937
Mailing Address - Fax:843-725-1434
Practice Address - Street 1:9565 HIGHWAY 78
Practice Address - Street 2:BLDG 900
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3912
Practice Address - Country:US
Practice Address - Phone:843-824-3937
Practice Address - Fax:843-725-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDG8451OtherRR MEDICARE
SCDG8451OtherRR MEDICARE
SC7634Medicare PIN