Healthcare Provider Details

I. General information

NPI: 1285635839
Provider Name (Legal Business Name): GORRIN'S CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E PARK AVE
GREENVILLE SC
29601-1629
US

IV. Provider business mailing address

11 E PARK AVE
GREENVILLE SC
29601-1629
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-2270
  • Fax: 864-235-4327
Mailing address:
  • Phone: 864-233-2270
  • Fax: 864-235-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH O GORRIN JR.
Title or Position: ANAPLASTOLOGIST/OCULARIST/OWNER
Credential: BCCA
Phone: 864-233-2270