# SUMTER OPTICAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801945019
- **Authorized official:** MRS. KRISTIN ELIZABETH GAY (BILLING)
- **Authorized official phone:** (803) 905-8047

## Contact information

- **Practice address:** 365 WEST WESMARK BLVD, SUMTER, SC 29150
- **Practice address phone:** (803) 905-8047
- **Practice address fax:** (803) 905-8047
- **Mailing address:** 365 WEST WESMARK BLVD, SUMTER, SC 29150
- **Mailing address phone:** (803) 905-8047
- **Mailing address fax:** (803) 905-8090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332H00000X | Eyewear Supplier | 043168838 | SC | — |
| 332H00000X | Eyewear Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 03/04/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP3423 | — | SC |