Organization
MEDIVISION, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA H CROWE (OFFICE ADMINSTRATOR)
(864) 638-9505
Entity
Organization
Contact information
Practice address
105 N EARLE ST, WALHALLA, SC 29691-2419
(864) 985-0691
(864) 638-9979
Mailing address
105 N EARLE ST, WALHALLA, SC 29691-2419
(864) 985-0691
(864) 638-9979
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0507
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1278480001
MEDICARE DME
SC
05
—
DA9882
—
SC
Enumeration date
02/03/2006
Last updated
02/06/2008
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