Organization
WESTSIDE EYE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE E ROEL M.D. (OWNER)
(864) 574-7767
Entity
Organization
Contact information
Practice address
1413 JOHN B WHITE SR BLVD, SUITE D, SPARTANBURG, SC 29306-3995
(864) 574-7767
Mailing address
735 EAST MAIN ST, SPARTANBURG, SC 29302-1281
(864) 542-1308
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
14463
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ASC056
—
SC
Enumeration date
05/11/2006
Last updated
11/13/2007
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