Provider Demographics
NPI:1245329853
Name:OLIVER EYE ASSOCIATES PA
Entity type:Organization
Organization Name:OLIVER EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:CPOC
Authorized Official - Phone:803-327-1181
Mailing Address - Street 1:46 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1529
Mailing Address - Country:US
Mailing Address - Phone:803-628-5477
Mailing Address - Fax:803-628-5474
Practice Address - Street 1:46 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1529
Practice Address - Country:US
Practice Address - Phone:803-628-5477
Practice Address - Fax:803-628-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9906Medicaid
SC0560980001Medicare NSC
SC8687Medicare PIN