Provider Demographics
NPI:1720044514
Name:COLUMBIA EYE CLINIC PA
Entity Type:Organization
Organization Name:COLUMBIA EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANGSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-779-3070
Mailing Address - Street 1:PO BOX 60371
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0371
Mailing Address - Country:US
Mailing Address - Phone:803-779-3070
Mailing Address - Fax:803-771-7639
Practice Address - Street 1:1920 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-779-3070
Practice Address - Fax:803-771-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0187Medicaid
SC1357Medicare PIN