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General NPI Number Information
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NPI Number | 1659315802
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Entity Type | Organization
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Legal Business Name | AIKEN OPHTHALMOLOGY PC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 110 PEPPER HILL WAY
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City | AIKEN
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State | SC
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Zip | 29801-2818
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Country | US
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Telephone | 803-642-6060
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Fax | 803-642-0754
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Provider Business Mailing Address
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Address Line | 110 PEPPER HILL WAY
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City | AIKEN
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State | SC
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Zip | 29801-2818
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Country | US
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Telephone | 803-642-6060
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Fax | 803-642-0754
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DENISE L KROK
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Credential | COE, ST
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Telephone | 803-642-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 21946
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License Number State | SC
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