Provider Demographics
NPI:1730110537
Name:CRESON, STUART P (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:P
Last Name:CRESON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-214-1834
Mailing Address - Fax:864-214-1824
Practice Address - Street 1:1451 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-214-1834
Practice Address - Fax:864-214-1824
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC01218152W00000X
SC1218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12190Medicaid
T30156Medicare UPIN
SCD12190Medicaid