Provider Demographics
NPI:1881641660
Name:EASLEY EYE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:EASLEY EYE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-855-6800
Mailing Address - Street 1:112 JOHN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1472
Mailing Address - Country:US
Mailing Address - Phone:864-855-6800
Mailing Address - Fax:864-855-6850
Practice Address - Street 1:112 JOHN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1472
Practice Address - Country:US
Practice Address - Phone:864-855-6800
Practice Address - Fax:864-855-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2420Medicaid
SC8118Medicare ID - Type UnspecifiedMEDICARE GROUP #