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General NPI Number Information
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NPI Number | 1972049229
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Entity Type | Organization
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Legal Business Name | EYEWEAR BY DAVID
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 927 UNIVERSITY DR
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City | LANCASTER
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State | SC
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Zip | 29720-9496
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Country | US
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Telephone | 803-416-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16
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City | LANCASTER
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State | SC
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Zip | 29721-0016
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Country | US
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Telephone | 803-416-3937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID GHENT
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Credential | OPTICIAN
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Telephone | 803-416-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 648
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License Number State | SC
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