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Organization

WESTSIDE OPTICAL SHOP,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LAWRENCE EDMUND ROEL MD (OWNER/PROVIDER)
(864) 542-1308
Entity
Organization

Contact information

Practice address
1413 JOHN B WHITE SR BLVD, SUITE A, SPARTANBURG, SC 29306-3995
(864) 587-1039
(864) 587-1936
Mailing address
1413 JOHN B WHITE SR BLVD, SUITE A, SPARTANBURG, SC 29306-3995
(864) 587-1039
(864) 587-1936

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
120021119
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164472098
SC
Enumeration date
02/22/2012
Last updated
05/31/2012
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