Provider Demographics
NPI:1265418388
Name:GREENWOOD EYE CLINIC, P.A.
Entity type:Organization
Organization Name:GREENWOOD EYE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-227-2020
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0369
Mailing Address - Country:US
Mailing Address - Phone:864-227-2020
Mailing Address - Fax:864-227-2823
Practice Address - Street 1:665 WEST ALEXANDER ROAD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2013-01-28
Deactivation Date:2009-02-26
Deactivation Code:
Reactivation Date:2009-03-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0515Medicaid
SCCE6166OtherRAILROAD MEDICARE GROUP
SC0312620001Medicare NSC
SC1558Medicare PIN