Provider Demographics
NPI:1972934404
Name:NORTH SPARTANBURG EYE CENTER
Entity Type:Organization
Organization Name:NORTH SPARTANBURG EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-804-6412
Mailing Address - Street 1:8674 ASHEVILLE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-804-6412
Mailing Address - Fax:864-804-6413
Practice Address - Street 1:8674 ASHEVILLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316
Practice Address - Country:US
Practice Address - Phone:843-804-6412
Practice Address - Fax:843-357-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1545OtherMEDICAL LISC