Provider Demographics
NPI:1215933510
Name:SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Entity type:Organization
Organization Name:SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:642-220-0737
Mailing Address - Street 1:113 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5608
Mailing Address - Country:US
Mailing Address - Phone:864-269-3333
Mailing Address - Fax:864-295-1288
Practice Address - Street 1:113 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-269-3333
Practice Address - Fax:864-295-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1396841599OtherNPI
SC335998Medicaid
SC52668Medicaid
SC1053369777OtherNPI
SCDA9608Medicaid
SC153549Medicaid
SC1548218340OtherNPI
SC6180OtherMEDICARE GROUP NUMBER GREER OFFICE
SC1760431035OtherNPI
SCD17998Medicaid
SCTL5190Medicaid
SC130735Medicaid
SC1437107836OtherNPI
SC1639127046OtherNPI
SCPA6449Medicaid
SCT48026Medicaid
MO1205122975OtherNPI
SC1571OtherMEDICARE GROUP GREENVILLE OFFICE NUMBER
SC1821439878OtherNPI
SC1295886125OtherNPI
SCGP2766Medicaid
SCT48026Medicaid
SC6180OtherMEDICARE GROUP NUMBER GREER OFFICE
SC1571OtherMEDICARE GROUP GREENVILLE OFFICE NUMBER
SC1437107836OtherNPI
SCC46958Medicare UPIN
SCSC61791571Medicare UPIN
SC153549Medicaid
SC335998Medicaid
SCTL5190Medicaid
SC1548218340OtherNPI
SCG84743Medicare UPIN