Provider Demographics
NPI:1821294992
Name:JOHN HINDERSMAN
Entity Type:Organization
Organization Name:JOHN HINDERSMAN
Other - Org Name:CAROLINA LASER VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDERSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-799-0585
Mailing Address - Street 1:2750 LAUREL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2023
Mailing Address - Country:US
Mailing Address - Phone:803-799-0585
Mailing Address - Fax:
Practice Address - Street 1:2750 LAUREL ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2023
Practice Address - Country:US
Practice Address - Phone:803-799-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007387174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC073878Medicaid
SC073878Medicaid
SC1981Medicare ID - Type Unspecified