Healthcare Provider Details

I. General information

NPI: 1730617200
Provider Name (Legal Business Name): IVISION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 HAZEL ST
FORT MILL SC
29708-0029
US

IV. Provider business mailing address

9700 REDSTONE DR STE 300
INDIAN LAND SC
29707-5409
US

V. Phone/Fax

Practice location:
  • Phone: 224-848-9385
  • Fax:
Mailing address:
  • Phone: 803-548-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BHUMIKA PATEL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 224-848-9385