| |
321 Bacon St, Edgefield, SC 29824-1397 | |
(803) 637-3141 | |
(803) 637-0394 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 321 Bacon St, Edgefield, South Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508920646 | NPI | - | NPPES |
DA9995 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 974 (South Carolina) | Primary |
Mailing Address | Practice Location Address |
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Po Box 387, Edgefield, SC 29824-0387 Ph: (803) 637-3141 | 321 Bacon St, Edgefield, SC 29824-1397 Ph: (803) 637-3141 |