Provider Demographics
NPI:1760573984
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 1:1920 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2632
Mailing Address - Country:US
Mailing Address - Phone:803-779-3070
Mailing Address - Fax:
Practice Address - Street 1:100 PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-806-0080
Practice Address - Fax:803-356-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0187Medicaid
SC1357Medicare ID - Type Unspecified