Healthcare Provider Details

I. General information

NPI: 1508156845
Provider Name (Legal Business Name): STEPHEN C SULYI, O.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SYLVAN OAK WAY
SIMPSONVILLE SC
29681-2562
US

IV. Provider business mailing address

117 SYLVAN OAK WAY
SIMPSONVILLE SC
29681-2562
US

V. Phone/Fax

Practice location:
  • Phone: 864-884-7432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SULYI
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 864-884-7432