Provider Demographics
NPI:1790719391
Name:LOFTIS & ASSOCIATES, PA
Entity Type:Organization
Organization Name:LOFTIS & ASSOCIATES, PA
Other - Org Name:EYE ON THE DREAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-798-8642
Mailing Address - Street 1:1219 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3135
Mailing Address - Country:US
Mailing Address - Phone:803-799-2020
Mailing Address - Fax:803-799-2035
Practice Address - Street 1:2430 ATLAS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3625
Practice Address - Country:US
Practice Address - Phone:803-254-5638
Practice Address - Fax:803-799-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9876Medicaid
SCDA9876Medicaid
SCT24678Medicare ID - Type Unspecified