Provider Demographics
NPI:1730495805
Name:BRINTON, EVAN M (OD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:BRINTON
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 1:8445 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7587
Mailing Address - Country:US
Mailing Address - Phone:803-431-7343
Mailing Address - Fax:803-431-7960
Practice Address - Street 1:8445 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7587
Practice Address - Country:US
Practice Address - Phone:803-431-7343
Practice Address - Fax:803-431-7960
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1925152W00000X
FLOPC 4562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1925OtherSTATE LICENSE
FLOPC 4562OtherSTATE LICENSE