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General NPI Number Information
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NPI Number | 1174619423
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Entity Type | Organization
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Legal Business Name | CLARENDON EYE CENTER P A
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 1774 PAXVILLE HWY
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City | MANNING
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State | SC
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Zip | 29102-5071
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Country | US
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Telephone | 803-435-2494
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Fax | 803-435-8765
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Provider Business Mailing Address
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Address Line | 1774 PAXVILLE HWY
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City | MANNING
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State | SC
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Zip | 29102-5071
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Country | US
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Telephone | 803-435-2494
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Fax | 803-435-8765
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN J WEARDEN
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Credential | O.D.
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Telephone | 803-435-2494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1134
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License Number State | SC
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