Healthcare Provider Details

I. General information

NPI: 1730315151
Provider Name (Legal Business Name): SANSBURY EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LUCY LANE
COLUMBIA SC
29229
US

IV. Provider business mailing address

121 LUCY LANE
COLUMBIA SC
29229
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number204
License Number StateSC

VIII. Authorized Official

Name: SUSAN B KNEECE
Title or Position: INSURANCE MANAGER
Credential:
Phone: 803-781-2123