Healthcare Provider Details

I. General information

NPI: 1285817239
Provider Name (Legal Business Name): MELISSA L BINDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 BROAD ST STE 48
SUMTER SC
29150-2567
US

IV. Provider business mailing address

1057 BROAD ST STE 48
SUMTER SC
29150-2565
US

V. Phone/Fax

Practice location:
  • Phone: 803-775-8950
  • Fax: 803-775-8955
Mailing address:
  • Phone: 803-775-8950
  • Fax: 803-775-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1318
License Number StateSC

VIII. Authorized Official

Name: DR. MELISSA BINDER
Title or Position: OWNER
Credential: O.D.
Phone: 803-775-8950