Healthcare Provider Details

I. General information

NPI: 1922327543
Provider Name (Legal Business Name): ELECTRIC CITY EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807B E GREENVILLE ST
ANDERSON SC
29621-2034
US

IV. Provider business mailing address

212 THOMAS WELBORN RD
ANDERSON SC
29625-6401
US

V. Phone/Fax

Practice location:
  • Phone: 864-245-9161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1263
License Number StateSC

VIII. Authorized Official

Name: DOUGLAS REED
Title or Position: OWNER
Credential: OD
Phone: 864-245-9161