Provider Demographics
NPI:1649249541
Name:SCHEELE EYE ASSOCIATES, PC
Entity type:Organization
Organization Name:SCHEELE EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHEELE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-773-4313
Mailing Address - Street 1:127 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4225
Mailing Address - Country:US
Mailing Address - Phone:803-773-4313
Mailing Address - Fax:803-773-4314
Practice Address - Street 1:127 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4225
Practice Address - Country:US
Practice Address - Phone:803-773-4313
Practice Address - Fax:803-773-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9974Medicaid
SCT83764Medicare UPIN
SC0353360001Medicare NSC
SCDA9974Medicaid