Healthcare Provider Details

I. General information

NPI: 1265418388
Provider Name (Legal Business Name): GREENWOOD EYE CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date: 02/26/2009
Reactivation Date: 03/09/2009

III. Provider practice location address

665 WEST ALEXANDER ROAD
GREENWOOD SC
29646
US

IV. Provider business mailing address

PO BOX 369
GREENWOOD SC
29648-0369
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-2020
  • Fax:
Mailing address:
  • Phone: 864-227-2020
  • Fax: 864-227-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY M. ESCO
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 864-227-2020