| |
190 Rental Dr., Holly Hill, SC 29059 | |
(803) 496-5261 | |
(803) 496-5261 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 190 Rental Dr., Holly Hill, South Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1891932125 | NPI | - | NPPES |
DA9713 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1053 (South Carolina) | Primary |
Mailing Address | Practice Location Address |
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Po Box 1030, Holly Hill, SC 29059-1030 Ph: (803) 496-5261 | 190 Rental Dr., Holly Hill, SC 29059 Ph: (803) 496-5261 |