Provider Demographics
NPI:1134189442
Name:OCONEE OPHTHALMOLOGY PA
Entity type:Organization
Organization Name:OCONEE OPHTHALMOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:AXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-882-7845
Mailing Address - Street 1:PO BOX 1435
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679
Mailing Address - Country:US
Mailing Address - Phone:864-882-7845
Mailing Address - Fax:864-882-7822
Practice Address - Street 1:304 123 BYPASS
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-7845
Practice Address - Fax:864-882-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223204Medicaid
SC2349Medicare PIN
SC223204Medicaid