Provider Demographics
NPI:1972712008
Name:SENECA OPTICIANS INC
Entity Type:Organization
Organization Name:SENECA OPTICIANS INC
Other - Org Name:SENECA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MEADE
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO LICENSED DISPENS
Authorized Official - Phone:864-882-3255
Mailing Address - Street 1:1598 SANDIFER BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0929
Mailing Address - Country:US
Mailing Address - Phone:864-882-3255
Mailing Address - Fax:864-882-3591
Practice Address - Street 1:1598 SANDIFER BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0929
Practice Address - Country:US
Practice Address - Phone:864-882-3255
Practice Address - Fax:864-882-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC739156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV7396Medicaid
SCDV7396Medicaid