Provider Demographics
NPI:1932179934
Name:DYCHES, VAL S JR (OD)
Entity Type:Individual
Prefix:DR
First Name:VAL
Middle Name:S
Last Name:DYCHES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3048
Mailing Address - Country:US
Mailing Address - Phone:864-859-3233
Mailing Address - Fax:864-850-4001
Practice Address - Street 1:601 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3403
Practice Address - Country:US
Practice Address - Phone:864-458-7956
Practice Address - Fax:864-458-8390
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05046Medicaid
SC4489633OtherAETNA PROVIDER NUMBER
SC3089807002OtherCIGNA PROVIDER NUMBER
SC3089807002OtherCIGNA PROVIDER NUMBER