Organization
RUFUS B. ANTLEY, OD
Active
Other names
Wagener Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA L. ANTLEY (OFFICE MANAGER)
(803) 532-9870
Entity
Organization
Contact information
Practice address
149 N. MAIN ST, WAGENER, SC 29164
(803) 564-6728
(803) 564-6750
Mailing address
PO BOX 130, WAGENER, SC 29164
(803) 564-6728
(803) 564-6750
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
433
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA9844
—
SC
Enumeration date
10/25/2006
Last updated
04/20/2008
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