Organization
DONITA L VADE OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONITA LOU VADE O.D. (MANAGER)
(864) 644-9014
Entity
Organization
Contact information
Practice address
220 N MAIN ST STE 500, GREENVILLE, SC 29601-2129
(864) 275-8775
Mailing address
2123 OLD SPARTANBURG RD, NUM 320, GREER, SC 29650-2704
(864) 644-9014
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1610
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669519864
INVIDIUAL NPI
SC
01
—
AA91100281
MEDICARE PTAN
SC
Enumeration date
11/05/2013
Last updated
11/02/2018
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