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General NPI Number Information
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NPI Number | 1669064036
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Entity Type | Organization
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Legal Business Name | FAMILY OPTOMETRIC ASSOCIATES P.C.
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 4119 MOSEBY ST
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City | COLUMBIA
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State | SC
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Zip | 29207-6119
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Country | US
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Telephone | 803-790-1849
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Fax |
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Provider Business Mailing Address
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Address Line | 8210 SKIPWITH DR
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City | FREDERICK
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State | MD
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Zip | 21702-9499
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ASHLEY SHEIDY
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Credential | COO
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Telephone | 240-656-8181
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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 |
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License Number State |
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