Healthcare Provider Details

I. General information

NPI: 1740353093
Provider Name (Legal Business Name): EYE ASSOCIATES OF CAYCE WEST COLUMBIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 KNOX ABBOTT DRIVE
CAYCE SC
29033-4127
US

IV. Provider business mailing address

600 KNOX ABBOTT DRIVE
CAYCE SC
29033-4127
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-4444
  • Fax: 803-794-2085
Mailing address:
  • Phone: 803-794-4444
  • Fax: 803-794-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIANNE S KLECKLEY
Title or Position: DOCTOR OWNER
Credential: OD
Phone: 803-794-4444