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General NPI Number Information
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NPI Number | 1568404044
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF LITTLE RIVER, LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 4000 HIGHWAY 9 E SUITE 260
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7833
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Country | US
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Telephone | 843-390-0058
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Fax | 843-390-0999
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Provider Business Mailing Address
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Address Line | 4000 HIGHWAY 9 E SUITE 260
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7833
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Country | US
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Telephone | 843-390-0058
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Fax | 843-390-0999
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JASON L. DIAMOND
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Credential | O.D.
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Telephone | 843-333-5435
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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 | 1409
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1408
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License Number State | SC
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