Healthcare Provider Details

I. General information

NPI: 1003851775
Provider Name (Legal Business Name): EYE ASSOCIATES OF WINNSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 KINCAID BRIDGE RD
WINNSBORO SC
29180-7113
US

IV. Provider business mailing address

1007 KINCAID BRIDGE RD
WINNSBORO SC
29180-7113
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-6496
  • Fax: 803-635-6932
Mailing address:
  • Phone: 803-635-6496
  • Fax: 803-635-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0705
License Number StateSC

VIII. Authorized Official

Name: JOEL G BAILEY
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 803-635-6496