| |
149 N. Main St, Wagener, SC 29164 | |
(803) 564-6728 | |
(803) 564-6750 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 149 N. Main St, Wagener, South Carolina |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1124103536 | NPI | - | NPPES |
DA9844 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 433 (South Carolina) | Primary |
Mailing Address | Practice Location Address |
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Po Box 130, Wagener, SC 29164 Ph: (803) 564-6728 | 149 N. Main St, Wagener, SC 29164 Ph: (803) 564-6728 |