=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437943172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENECA EYE CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2025
-----------------------------------------------------
Last Update Date | 11/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1636 SANDIFER BLVD
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29678-0906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-735-1574
-----------------------------------------------------
Fax | 864-309-8022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1636 SANDIFER BLVD
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29678-0906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD, OWNER
-----------------------------------------------------
Name | VALERIE CECELIA FERRELL
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 864-735-1574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------