Healthcare Provider Details

I. General information

NPI: 1457841991
Provider Name (Legal Business Name): EYE GUYS CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 SILVER BLUFF RD
AIKEN SC
29803-6055
US

IV. Provider business mailing address

1330 INTERSTATE PKWY
AUGUSTA GA
30909-5625
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-2020
  • Fax: 706-651-2032
Mailing address:
  • Phone: 706-651-2020
  • Fax: 706-651-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA L MCFATRIDGE
Title or Position: CFO
Credential:
Phone: 706-651-2020