Provider Demographics
NPI:1396724472
Name:BLACKWELL EYE ASSOCIATES, P. A.
Entity type:Organization
Organization Name:BLACKWELL EYE ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRITT
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-327-2001
Mailing Address - Street 1:1268 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2341
Mailing Address - Country:US
Mailing Address - Phone:803-327-2001
Mailing Address - Fax:803-327-9843
Practice Address - Street 1:1268 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2341
Practice Address - Country:US
Practice Address - Phone:803-327-2001
Practice Address - Fax:803-327-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9891Medicaid
0350110001Medicare NSC
SC5145Medicare PIN