Organization
OPTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICKOLAS VASTIS O.D. (PRESIDENT)
(803) 409-8333
Entity
Organization
Contact information
Practice address
1510 ONYX RIDGE RD, SUITE 101, FORT MILL, SC 29708
(803) 802-3937
Mailing address
1510 ONYX RIDGE, SUITE 101, FORT MILL, SC 29708
(803) 802-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
SC
Other
Enumeration date
10/16/2012
Last updated
07/16/2014
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