Provider Demographics
NPI:1447499181
Name:ORANGEBURG FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:ORANGEBURG FAMILY EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTPMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-534-2352
Mailing Address - Street 1:1605 CAROLINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4939
Mailing Address - Country:US
Mailing Address - Phone:803-534-2352
Mailing Address - Fax:803-534-2180
Practice Address - Street 1:1605 CAROLINA AVENUE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4939
Practice Address - Country:US
Practice Address - Phone:803-534-2352
Practice Address - Fax:803-534-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05591Medicaid
P00617033OtherRAILROAD
P00468595OtherRAILROAD
P00468595OtherRAILROAD
SCD05591Medicaid
0146780003Medicare NSC
0146780001Medicare NSC
T238274094Medicare PIN