Provider Demographics
NPI:1215153390
Name:GOSNELL CHAPMAN VISION CENTER
Entity type:Organization
Organization Name:GOSNELL CHAPMAN VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOSNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:864-269-1475
Mailing Address - Street 1:100C SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4413
Mailing Address - Country:US
Mailing Address - Phone:864-269-1475
Mailing Address - Fax:864-269-1475
Practice Address - Street 1:100C SIMPSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4413
Practice Address - Country:US
Practice Address - Phone:864-269-1475
Practice Address - Fax:864-269-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC428332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDVO428Medicaid
SCDVO428Medicaid