Organization
MONTGOMERY & RIDDLE EYECARE, PA
Active
Other names
Montgomery Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL JACOB MONTGOMERY JR. M.D. (PRESIDENT)
(864) 833-0038
Entity
Organization
Contact information
Practice address
22995 HIGHWAY 76 E, CLINTON, SC 29325-7529
(864) 833-0038
(864) 833-0520
Mailing address
22995 HIGHWAY 76 E, CLINTON, SC 29325-7529
(864) 833-0038
(864) 833-0520
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7427
MEDICARE GROUP NUMBER
SC
01
—
CJ9961
RAILROAD MEDICARE
SC
05
—
GP3567
—
SC
Enumeration date
06/16/2006
Last updated
03/15/2017
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