MEDICARE: CAROLINA VISION ASSOCIATES, LLC

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
1	152W00000X	Optometrist	654	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9701	OTHER	SC	RAILROAD MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255357356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA VISION ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	180 N. DEAN STREET
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1517
Country	:	US
Telephone Number	:	864-583-3125
Fax Number	:	864-542-1367

Provider Business Practice Location Address
First Line	:	180 N. DEAN STREET
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1517
Country	:	US
Telephone Number	:	864-583-3125
Fax Number	:	864-542-1367

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. KIMBERLY WILLARD
Credential	:
Telephone Number	:	864-583-3125

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/11/2013

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