Provider Demographics
NPI:1922736834
Name:CAROLINA FAMILY EYECARE ROCK HILL LLC
Entity Type:Organization
Organization Name:CAROLINA FAMILY EYECARE ROCK HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-724-6057
Mailing Address - Street 1:1307 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2336
Mailing Address - Country:US
Mailing Address - Phone:803-324-3979
Mailing Address - Fax:803-324-3925
Practice Address - Street 1:1307 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2336
Practice Address - Country:US
Practice Address - Phone:803-324-3979
Practice Address - Fax:803-324-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1396708475OtherINDIVIDUAL NPI