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General NPI Number Information
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NPI Number | 1205048964
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Entity Type | Organization
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Legal Business Name | MONTAGUE EYE CENTER LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 711 MONTAGUE AVE
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City | GREENWOOD
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State | SC
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Zip | 29649
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Country | US
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Telephone | 864-229-2301
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Fax | 864-229-1898
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Provider Business Mailing Address
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Address Line | 711 MONTAGUE AVE PO BOX 1206
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City | GREENWOOD
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State | SC
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Zip | 29649
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Country | US
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Telephone | 864-229-2301
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Fax | 864-229-1898
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER R LIPPENS
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Credential | OD
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Telephone | 864-229-2301
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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 | 1280
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License Number State | SC
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