Organization
CAROLINA VISION ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY WILLARD (PRACTICE ADMINISTRATOR)
(864) 583-3125
Entity
Organization
Contact information
Practice address
180 N. DEAN STREET, SPARTANBURG, SC 29302-1517
(864) 583-3125
(864) 542-1367
Mailing address
180 N. DEAN STREET, SPARTANBURG, SC 29302-1517
(864) 583-3125
(864) 542-1367
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
654
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ9701
RAILROAD MEDICARE GROUP #
SC
05
—
D10496
—
SC
05
—
D10502
—
SC
05
—
D10664
—
SC
05
—
D10924
—
SC
05
—
DA9715
—
SC
05
—
DA9716
—
SC
05
—
DA9717
—
SC
05
—
DA9837
—
SC
05
—
DO6544
—
SC
05
—
DO9621
—
SC
Enumeration date
07/14/2006
Last updated
04/11/2013
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