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NPI Code Detail

MEDICARE: DEVINE EYES INC

MEDICARE: DEVINE EYES INC
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
1152W00000XOptometrist040649753SC

General Provider Information

NPI Number : 1366481210
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEVINE EYES INC
Provider Business Mailing Address
First Line : 2421 DEVINE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29205-2405
Country : US
Telephone Number : 803-376-4545
Fax Number : 803-254-2324
Provider Business Practice Location Address
First Line : 2421 DEVINE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29205-2405
Country : US
Telephone Number : 803-376-4545
Fax Number : 803-254-2324
Authorized Official
Title or Position : DIRECTOR
Name : DR. DAVID JEFFERY MATTHEWS
Credential : O.D.
Telephone Number : 803-376-4545
Provider Enumeration Date : 06/06/2006
Last Update Date : 03/19/2018

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Directions to “DEVINE EYES INC ” Practice Location

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