Provider Demographics
NPI:1295922235
Name:GHENT, DAVID A (OPTICIAN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GHENT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S WYLIE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2353
Mailing Address - Country:US
Mailing Address - Phone:803-285-7400
Mailing Address - Fax:803-285-7554
Practice Address - Street 1:209 S WYLIE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2353
Practice Address - Country:US
Practice Address - Phone:803-285-7400
Practice Address - Fax:803-285-7554
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC648156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV6486Medicaid