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General NPI Number Information
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NPI Number | 1558992578
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Entity Type | Organization
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Legal Business Name | CARDINAL VISION LLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 4723A SUNSET BLVD
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City | LEXINGTON
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State | SC
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Zip | 29072-9151
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Country | US
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Telephone | 843-597-2912
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Fax |
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Provider Business Mailing Address
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Address Line | 5 RIDGE CLIFF CT
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City | IRMO
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State | SC
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Zip | 29063-7928
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Country | US
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Telephone | 803-999-3937
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. GAVIN DAVIS
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Credential | MD
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Telephone | 803-999-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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