Provider Demographics
NPI:1811156359
Name:ENVISION FAMILY EYECARE,LLC
Entity type:Organization
Organization Name:ENVISION FAMILY EYECARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-996-2020
Mailing Address - Street 1:5166 SUNSET BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9258
Mailing Address - Country:US
Mailing Address - Phone:803-808-2917
Mailing Address - Fax:
Practice Address - Street 1:5166 SUNSET BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9258
Practice Address - Country:US
Practice Address - Phone:803-351-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1427152W00000X
SC1291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty