Healthcare Provider Details

I. General information

NPI: 1639130305
Provider Name (Legal Business Name): BLUE RIDGE EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BY PASS 123 SUITE C
SENECA SC
29678-0844
US

IV. Provider business mailing address

530 BY PASS 123 STE C
SENECA SC
29678-0859
US

V. Phone/Fax

Practice location:
  • Phone: 864-985-1110
  • Fax: 864-985-1410
Mailing address:
  • Phone: 864-985-1110
  • Fax: 864-985-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5655540001
License Number StateSC

VIII. Authorized Official

Name: SCOTT CHRISTOPHER MASSIOS
Title or Position: OWNER
Credential:
Phone: 864-985-1110