Provider Demographics
NPI:1528459062
Name:CAROLINA OPTICAL, LLC
Entity type:Organization
Organization Name:CAROLINA OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-833-0038
Mailing Address - Street 1:503 W BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-1313
Mailing Address - Country:US
Mailing Address - Phone:864-445-2103
Mailing Address - Fax:864-445-9696
Practice Address - Street 1:503 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-1313
Practice Address - Country:US
Practice Address - Phone:864-445-2103
Practice Address - Fax:864-445-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier