Provider Demographics
NPI:1740474048
Name:SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Entity type:Organization
Organization Name:SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-220-0737
Mailing Address - Street 1:113 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5608
Mailing Address - Country:US
Mailing Address - Phone:864-269-3333
Mailing Address - Fax:864-295-1288
Practice Address - Street 1:100 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2445
Practice Address - Country:US
Practice Address - Phone:864-269-3333
Practice Address - Fax:864-295-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1821439878OtherNPI
SC1295886125OtherNPI
SC153549Medicaid
SC33599Medicaid
SCD17998Medicaid
SC1205122975OtherNPI
SC130735Medicaid
SC1437107836OtherNPI
SC1760431035OtherNPI
SC52668Medicaid
SCT48026Medicaid
SC1053369777OtherNPI
SC6180OtherMEDICARE GROUP
SCGP2766Medicaid
SC1740474048OtherNPI
SC1396841599OtherNPI
SC1548218340OtherNPI
SCDA9608Medicaid
SCTL5190Medicaid
SC1639127046OtherNPI
SCG84743Medicare UPIN
SC130735Medicaid
SC6180OtherMEDICARE GROUP
SC1821439878OtherNPI
SCD17998Medicaid
SC1740474048OtherNPI
SCSC61796180Medicare UPIN
SCT48026Medicaid
SC1760431035OtherNPI
SCSC30051571Medicare UPIN