Basic Information
| Provider Information | |||||||||
| NPI: | 1730617200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IVISION ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1569 HAZEL ST | ||||||||
| Address2: | |||||||||
| City: | TEGA CAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297080029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2248489385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 749 UNIVERSITY VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | BLYTHEWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290167613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037141116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 05/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | BHUMIKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 2248489385 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.