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General NPI Number Information
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NPI Number | 1457451510
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Entity Type | Organization
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Legal Business Name | EASTSIDE EYE CENTER PA
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 735 E MAIN ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1281
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Country | US
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Telephone | 864-542-1308
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Fax |
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Provider Business Mailing Address
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Address Line | 735 E MAIN ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-1281
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Country | US
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Telephone | 864-542-1308
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE E ROEL
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Credential | MD
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Telephone | 864-542-1308
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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 | 14463
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License Number State | SC
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