Healthcare Provider Details

I. General information

NPI: 1588661649
Provider Name (Legal Business Name): HEBER GRANT SIMS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353A E BLACKSTOCK RD
SPARTANBURG SC
29301-3762
US

IV. Provider business mailing address

353A E BLACKSTOCK RD
SPARTANBURG SC
29301-3762
US

V. Phone/Fax

Practice location:
  • Phone: 864-574-0366
  • Fax: 864-574-0367
Mailing address:
  • Phone: 864-574-0366
  • Fax: 864-574-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number565
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number565
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: