=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679046569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE ASSOCIATES OF SC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2019
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 E 2ND NORTH ST
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29483-6858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-851-1037
-----------------------------------------------------
Fax | 843-851-1392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 880
-----------------------------------------------------
City | FORT WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19034-0880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-906-9993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RUSSELL OSNES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 866-523-7999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------