MEDICARE: ANDREWS VISION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	694	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316900863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREWS VISION CENTER

Provider Business Mailing Address
First Line	:	21 E MAIN ST
Second Line	:
City	:	ANDREWS
State	:	SC
Zip	:	29510-2635
Country	:	US
Telephone Number	:	843-264-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 E MAIN ST
Second Line	:
City	:	ANDREWS
State	:	SC
Zip	:	29510-2635
Country	:	US
Telephone Number	:	843-264-5200
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	MELINDA M POSTON
Credential	:
Telephone Number	:	843-650-2400

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/16/2008

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