Provider Demographics
NPI:1740353093
Name:EYE ASSOCIATES OF CAYCE WEST COLUMBIA
Entity type:Organization
Organization Name:EYE ASSOCIATES OF CAYCE WEST COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLECKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-794-4444
Mailing Address - Street 1:600 KNOX ABBOTT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4127
Mailing Address - Country:US
Mailing Address - Phone:803-794-4444
Mailing Address - Fax:803-794-2085
Practice Address - Street 1:600 KNOX ABBOTT DRIVE
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4127
Practice Address - Country:US
Practice Address - Phone:803-794-4444
Practice Address - Fax:803-794-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0627220001OtherDMERC
SCDA9984Medicaid
SCDA9984Medicaid