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NPI Code Detail

MEDICARE: DONITA L VADE OD LLC

MEDICARE: DONITA L VADE OD LLC
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
1152W00000XOptometrist1610SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2AA91100281OTHERSCMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11669519864OTHERSCINVIDIUAL NPI

General Provider Information

NPI Number : 1497184972
Entity Type Code : Organization
Provider Name (Legal Business Name) : DONITA L VADE OD LLC
Provider Business Mailing Address
First Line : 2123 OLD SPARTANBURG RD
Second Line : NUM 320
City : GREER
State : SC
Zip : 29650-2704
Country : US
Telephone Number : 864-644-9014
Fax Number :
Provider Business Practice Location Address
First Line : 220 N MAIN ST STE 500
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2129
Country : US
Telephone Number : 864-275-8775
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DR. DONITA LOU VADE
Credential : O.D.
Telephone Number : 864-644-9014
Provider Enumeration Date : 11/05/2013
Last Update Date : 11/02/2018

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