Provider Demographics
NPI:1952469348
Name:JEWELL VISION CARE
Entity Type:Organization
Organization Name:JEWELL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-283-2020
Mailing Address - Street 1:689 LANCASTER BYP E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-4727
Mailing Address - Country:US
Mailing Address - Phone:803-283-2020
Mailing Address - Fax:803-286-0734
Practice Address - Street 1:689 LANCASTER BYP E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4727
Practice Address - Country:US
Practice Address - Phone:803-283-2020
Practice Address - Fax:803-286-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6530OtherRAILROAD MEDICARE
SCDA9832Medicaid
SC6530OtherRAILROAD MEDICARE
SCDA9832Medicaid
0639090002Medicare NSC
6530Medicare PIN