=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003873308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCK HILL EYE CLINIC, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1565 EBENEZER RD
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-328-0168
-----------------------------------------------------
Fax | 803-325-8473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1773 EBENEZER RD
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-328-0168
-----------------------------------------------------
Fax | 803-325-8473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | KRISTINA LAURITZEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-981-5614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------