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General NPI Number Information
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NPI Number | 1497184972
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Entity Type | Organization
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Legal Business Name | DONITA L VADE OD LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 220 N MAIN ST STE 500
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City | GREENVILLE
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State | SC
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Zip | 29601-2129
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Country | US
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Telephone | 864-275-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 OLD SPARTANBURG RD NUM 320
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City | GREER
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State | SC
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Zip | 29650-2704
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Country | US
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Telephone | 864-644-9014
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DONITA LOU VADE
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Credential | O.D.
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Telephone | 864-644-9014
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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 | 1610
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License Number State | SC
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