Healthcare Provider Details

I. General information

NPI: 1710107446
Provider Name (Legal Business Name): UPSTATE VISION THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 A WINCHESTER CT
MAULDIN SC
29662
US

IV. Provider business mailing address

3 A WINCHESTER CT
MAULDIN SC
29662
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-5882
  • Fax: 864-288-5892
Mailing address:
  • Phone: 864-288-5882
  • Fax: 864-288-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BILLIE P SKINNER
Title or Position: PRESIDENT
Credential: OD
Phone: 864-288-5882