Healthcare Provider Details

I. General information

NPI: 1447785423
Provider Name (Legal Business Name): SANSBURY VISION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LUCY LN
COLUMBIA SC
29229-7835
US

IV. Provider business mailing address

PO BOX 1107
IRMO SC
29063-1107
US

V. Phone/Fax

Practice location:
  • Phone: 803-217-2550
  • Fax: 803-217-2548
Mailing address:
  • Phone: 803-781-2123
  • Fax: 803-749-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberSC0838
License Number StateSC

VIII. Authorized Official

Name: MR. RAY A SANSBURY
Title or Position: CEO
Credential: OPTICIAN
Phone: 803-781-2123