Provider Demographics
NPI:1700063716
Name:SINGLETON EYE INC
Entity Type:Organization
Organization Name:SINGLETON EYE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-449-2020
Mailing Address - Street 1:1300 HIGHWAY 544 UNIT B
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-6592
Mailing Address - Country:US
Mailing Address - Phone:843-449-2020
Mailing Address - Fax:843-839-5123
Practice Address - Street 1:6151 R C SARVIS RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-8107
Practice Address - Country:US
Practice Address - Phone:843-267-1061
Practice Address - Fax:843-839-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC603305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06036Medicaid
SC6073550001OtherMEDICARE DMERC
SCDA9810Medicaid
SCDA9810Medicaid
SC6073550001OtherMEDICARE DMERC
SC0282Medicare PIN