Provider Demographics
NPI:1811629280
Name:EASTERLING, TINA DAVIS (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:DAVIS
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:322 BLANCHE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4907
Mailing Address - Country:US
Mailing Address - Phone:704-617-8585
Mailing Address - Fax:803-578-4137
Practice Address - Street 1:1151 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6555
Practice Address - Country:US
Practice Address - Phone:803-578-4135
Practice Address - Fax:803-578-4137
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC956156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician