Provider Demographics
NPI:1891770020
Name:WESTMINSTER VISION ASSOCIATES
Entity Type:Organization
Organization Name:WESTMINSTER VISION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-654-4141
Mailing Address - Street 1:1390 TIGER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2617
Mailing Address - Country:US
Mailing Address - Phone:864-654-4141
Mailing Address - Fax:864-654-4144
Practice Address - Street 1:1390 TIGER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2617
Practice Address - Country:US
Practice Address - Phone:864-654-4141
Practice Address - Fax:864-654-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1040152W00000X
CT002217152W00000X
MD73286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA410037186OtherRAILROAD RETIREMENT
SC5826Medicare PIN
TN1210330001Medicare NSC