=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962689737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYES-ON-WHEELS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2008
-----------------------------------------------------
Last Update Date | 01/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1823 SHADOWOOD DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-413-1469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1823 SHADOWOOD DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-413-1469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED OPTICIAN
-----------------------------------------------------
Name | MS. GILDA ARAMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-413-1469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------