Provider Demographics
NPI:1316246499
Name:ROCK HILL EYE CLINIC
Entity type:Organization
Organization Name:ROCK HILL EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-328-0168
Mailing Address - Street 1:1698 W. HWY 160
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7069
Mailing Address - Country:US
Mailing Address - Phone:803-547-9510
Mailing Address - Fax:803-547-9517
Practice Address - Street 1:1698 W. HWY 160
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7069
Practice Address - Country:US
Practice Address - Phone:803-547-9510
Practice Address - Fax:803-547-9517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK HILL EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3068Medicaid
SCAA31042041Medicare PIN