Provider Demographics
NPI:1912058900
Name:SPECS VISION CENTER OF AIKEN INC
Entity Type:Organization
Organization Name:SPECS VISION CENTER OF AIKEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-642-9902
Mailing Address - Street 1:792 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6055
Mailing Address - Country:US
Mailing Address - Phone:803-642-9902
Mailing Address - Fax:803-642-8611
Practice Address - Street 1:792 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6055
Practice Address - Country:US
Practice Address - Phone:803-642-9902
Practice Address - Fax:803-642-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC758152W00000X
SC1290152W00000X
SC831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12902Medicaid
SCDP8311Medicaid
SCD07589Medicaid
SCDP8311Medicaid
SCDP8311Medicaid
SCD07589Medicaid
SC=========OtherSPECS VISION CENTER OF AI
T695253774Medicare UPIN