MEDICARE: UNIVERSITY SPECIALTY CLINICS - OPHTHALMOLOGY

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	332H00000X	Eyewear Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0368630003	OTHER	SC	MEDICARE DME

General Provider Information

NPI Number	:	1942406434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY SPECIALTY CLINICS - OPHTHALMOLOGY

Provider Business Mailing Address
First Line	:	3555 HARDEN STREET EXT
Second Line	:	15 MEDICAL PARK, SUITE 300
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6894
Country	:	US
Telephone Number	:	803-545-5022
Fax Number	:	803-256-0977

Provider Business Practice Location Address
First Line	:	4 MEDICAL PARK RD
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6807
Country	:	US
Telephone Number	:	803-434-6836
Fax Number	:	803-434-1581

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	WILLIAM D ANDERSON
Credential	:	M.D.
Telephone Number	:	803-434-6836

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	02/07/2014

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Directions to “UNIVERSITY SPECIALTY CLINICS - OPHTHALMOLOGY ” Practice Location

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