Healthcare Provider Details

I. General information

NPI: 1558992578
Provider Name (Legal Business Name): CARDINAL VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723A SUNSET BLVD
LEXINGTON SC
29072-9151
US

IV. Provider business mailing address

5 RIDGE CLIFF CT
IRMO SC
29063-7928
US

V. Phone/Fax

Practice location:
  • Phone: 803-999-3937
  • Fax: 425-448-6516
Mailing address:
  • Phone: 803-999-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: GAVIN WADE DAVIS
Title or Position: PRINCIPLE
Credential:
Phone: 803-999-3937