Provider Demographics
NPI:1730140625
Name:LANCASTER EYE CLINIC P.A.
Entity Type:Organization
Organization Name:LANCASTER EYE CLINIC P.A.
Other - Org Name:THE EYE AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCIES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-475-2132
Mailing Address - Street 1:1240 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2200
Mailing Address - Country:US
Mailing Address - Phone:803-285-4333
Mailing Address - Fax:803-285-3472
Practice Address - Street 1:1240 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2200
Practice Address - Country:US
Practice Address - Phone:803-285-4333
Practice Address - Fax:803-285-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3870Medicaid
SCPA3870Medicaid