Healthcare Provider Details

I. General information

NPI: 1316164239
Provider Name (Legal Business Name): STORY EYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 02/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S WYLIE ST
LANCASTER SC
29720-2353
US

IV. Provider business mailing address

209 S WYLIE ST
LANCASTER SC
29720-2353
US

V. Phone/Fax

Practice location:
  • Phone: 803-285-7400
  • Fax: 803-285-7554
Mailing address:
  • Phone: 803-285-7400
  • Fax: 803-285-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number648
License Number StateSC

VIII. Authorized Official

Name: JOHN W STORY
Title or Position: OWNER
Credential: M.D.
Phone: 803-285-7400