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NPI Code Detail

MEDICARE: CLARENDON EYE CENTER P A

MEDICARE: CLARENDON EYE CENTER P A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1134SC

General Provider Information

NPI Number : 1174619423
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARENDON EYE CENTER P A
Provider Business Mailing Address
First Line : 1774 PAXVILLE HWY
Second Line :
City : MANNING
State : SC
Zip : 29102-5071
Country : US
Telephone Number : 803-435-2494
Fax Number : 803-435-8765
Provider Business Practice Location Address
First Line : 1774 PAXVILLE HWY
Second Line :
City : MANNING
State : SC
Zip : 29102-5071
Country : US
Telephone Number : 803-435-2494
Fax Number : 803-435-8765
Authorized Official
Title or Position : OWNER
Name : STEVEN J WEARDEN
Credential : O.D.
Telephone Number : 803-435-2494
Provider Enumeration Date : 10/05/2006
Last Update Date : 02/11/2008

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Directions to “CLARENDON EYE CENTER P A ” Practice Location

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