Provider Demographics
NPI:1790417517
Name:SERRANO, SYMBER (LDO, ABOC, NCLEC)
Entity Type:Individual
Prefix:
First Name:SYMBER
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LDO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WINSTON ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-1234
Mailing Address - Country:US
Mailing Address - Phone:864-295-0412
Mailing Address - Fax:864-295-0419
Practice Address - Street 1:6134 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3837
Practice Address - Country:US
Practice Address - Phone:864-295-0412
Practice Address - Fax:864-295-0419
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1116156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician