Provider Demographics
NPI:1194831586
Name:ORANGEBURG EYE CENTER
Entity type:Organization
Organization Name:ORANGEBURG EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-534-0266
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1226
Mailing Address - Country:US
Mailing Address - Phone:803-534-0266
Mailing Address - Fax:
Practice Address - Street 1:1190 SUMMERS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4922
Practice Address - Country:US
Practice Address - Phone:803-534-0266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2883Medicaid
SCCG9821OtherRAILROAD MEDICARE
SC6737Medicare ID - Type Unspecified