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General NPI Number Information
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NPI Number | 1245446392
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Entity Type | Organization
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Legal Business Name | ANDERSON OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 1116 CORNELIA RD
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City | ANDERSON
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State | SC
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Zip | 29622
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Country | US
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Telephone | 864-224-0028
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Fax | 864-225-5067
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Provider Business Mailing Address
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Address Line | 1116 CORNELIA RD
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City | ANDERSON
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State | SC
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Zip | 29621-3317
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Country | US
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Telephone | 864-224-0028
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Fax | 864-224-2030
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BORIS ILG
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Credential | MD
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Telephone | 864-224-0028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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