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General NPI Number Information
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NPI Number | 1861894115
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Entity Type | Organization
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Legal Business Name | PEE DEE EYE ASSOCIATES, PA
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 528 BROAD ST STE 101
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City | SUMTER
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State | SC
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Zip | 29150-3368
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Country | US
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Telephone | 803-775-1772
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Fax | 803-775-4729
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Provider Business Mailing Address
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Address Line | PO BOX 1956
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City | HARTSVILLE
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State | SC
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Zip | 29551-1956
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Country | US
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Telephone | 803-775-1772
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Fax | 803-775-4729
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANN RUSH
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Credential |
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Telephone | 843-332-7171
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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 | 1422
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License Number State | SC
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