=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205995354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECS VISION CENTER OF AIKEN, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 792 SILVER BLUFF RD
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29803-6055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-642-9902
-----------------------------------------------------
Fax | 803-642-8611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 792 SILVER BLUFF RD
-----------------------------------------------------
City | AIKEN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29803-6055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RHETT H RICHARDSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 803-642-9902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 758
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1290
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------