Basic Information
| Provider Information | |||||||||
| NPI: | 1265418388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENWOOD EYE CLINIC, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 369 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296480369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642272020 | ||||||||
| FaxNumber: | 8642272823 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 WEST ALEXANDER ROAD | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642272020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/26/2009 | ||||||||
| NPIReactivationDate: | 03/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ESCO | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8642272020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | PA0515 | 05 | SC | MEDICAID | CE6166 | 01 | SC | RAILROAD MEDICARE GROUP | OTHER |