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General NPI Number Information
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NPI Number | 1811074669
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Entity Type | Individual
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Provider Name | BROOK A VASTIS OD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 130 FORUM DRIVE SUITE 12
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-788-8204
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Fax | 803-788-8206
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Provider Business Mailing Address
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Address Line | 31519 WINTERPLACE PKWY SUITE 2
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City | SALISBURY
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State | MD
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Zip | 21804-1894
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Country | US
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Telephone | 410-749-1545
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Fax | 410-742-3707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1431
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License Number State | SC
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