Provider Demographics
NPI:1962774117
Name:APEX EYECARE LLC
Entity type:Organization
Organization Name:APEX EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-622-2058
Mailing Address - Street 1:133 SILVER LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2428
Mailing Address - Country:US
Mailing Address - Phone:803-622-2058
Mailing Address - Fax:803-781-0681
Practice Address - Street 1:7499 PARKLANE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7650
Practice Address - Country:US
Practice Address - Phone:803-622-2058
Practice Address - Fax:803-781-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393278Medicaid
SC1881669802Medicare PIN