Provider Demographics
NPI:1962957902
Name:INTEGRATED VISION ASSOCIATES LLC
Entity type:Organization
Organization Name:INTEGRATED VISION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-223-1960
Mailing Address - Street 1:110 OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2908
Mailing Address - Country:US
Mailing Address - Phone:864-223-1960
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3230
Practice Address - Country:US
Practice Address - Phone:864-223-1960
Practice Address - Fax:864-223-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9531Medicaid
SCDA9531Medicaid