Provider Demographics
NPI:1770580755
Name:POOLE, EDGAR MORGAN JR (OD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:MORGAN
Last Name:POOLE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:705 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1281
Mailing Address - Country:US
Mailing Address - Phone:864-585-3281
Mailing Address - Fax:864-585-2255
Practice Address - Street 1:705 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1281
Practice Address - Country:US
Practice Address - Phone:864-585-3281
Practice Address - Fax:864-585-2255
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0539152W00000X
SC539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05395Medicaid
SCD05395Medicaid
SCT24582Medicare UPIN
SC5884910001Medicare NSC