Provider Demographics
NPI:1952490237
Name:EYE ASSOCIATES OF CAYCE - WEST COLUMBIA
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF CAYCE - WEST COLUMBIA
Other - Org Name:EYE ASSOCIATES OF LEXINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-359-2294
Mailing Address - Street 1:314 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-359-2294
Mailing Address - Fax:803-359-1440
Practice Address - Street 1:600 KNOX ABBOTT DR
Practice Address - Street 2:
Practice Address - City:CAYCE WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29033
Practice Address - Country:US
Practice Address - Phone:803-794-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9983Medicaid
SCDA9983Medicaid