Provider Demographics
NPI:1457384729
Name:PALMETTO EYE & LASER CENTER, LLC
Entity Type:Organization
Organization Name:PALMETTO EYE & LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGUEWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-583-6381
Mailing Address - Street 1:479 HEYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1726
Mailing Address - Country:US
Mailing Address - Phone:864-583-6381
Mailing Address - Fax:864-583-6390
Practice Address - Street 1:1520 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5121
Practice Address - Country:US
Practice Address - Phone:864-583-6381
Practice Address - Fax:864-583-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7292OtherMEDICARE GROUP ID
SCCJ6730OtherRAILROAD MEDICARE GROUP
SCGP3396OtherMEDICAID GROUP