# MONTGOMERY & RIDDLE EYECARE, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montgomery Eye Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265476584
- **Authorized official:** DR. SAMUEL JACOB MONTGOMERY JR. M.D. (PRESIDENT)
- **Authorized official phone:** (864) 833-0038

## Contact information

- **Practice address:** 22995 HIGHWAY 76 E, CLINTON, SC 29325-7529
- **Practice address phone:** (864) 833-0038
- **Practice address fax:** (864) 833-0520
- **Mailing address:** 22995 HIGHWAY 76 E, CLINTON, SC 29325-7529
- **Mailing address phone:** (864) 833-0038
- **Mailing address fax:** (864) 833-0520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 03/15/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7427 | MEDICARE GROUP NUMBER | SC |
| 01 | — | CJ9961 | RAILROAD MEDICARE | SC |
| 05 | — | GP3567 | — | SC |