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General NPI Number Information
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NPI Number | 1831989771
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Entity Type | Organization
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Legal Business Name | SOUTHERN EYE ASSOCIATES OF SC, PA
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 110 MALL CONNECTOR DR
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City | GREENVILLE
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State | SC
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Zip | 29607-6830
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Country | US
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Telephone | 864-269-3333
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Fax | 864-626-0757
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Provider Business Mailing Address
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Address Line | 113 DOCTORS DR
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City | GREENVILLE
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State | SC
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Zip | 29605-5608
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Country | US
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Telephone | 864-269-3333
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Fax | 864-626-0757
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DENISE RIVERA
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Credential |
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Telephone | 864-268-3341
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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