Healthcare Provider Details

I. General information

NPI: 1306223201
Provider Name (Legal Business Name): STEVEN MICHAEL PITMAN SR. OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14326 E WADE HAMPTON BLVD
GREER SC
29651-1542
US

IV. Provider business mailing address

221 FISHER LAKE ROAD
GREER SC
29651-1542
US

V. Phone/Fax

Practice location:
  • Phone: 864-469-9113
  • Fax:
Mailing address:
  • Phone: 864-578-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number217
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number720
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: