Provider Demographics
NPI:1902927031
Name:SANSBURY EYE CENTER
Entity Type:Organization
Organization Name:SANSBURY EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:803-781-2123
Mailing Address - Street 1:205 COLUMBIA AVE
Mailing Address - Street 2:C
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2662
Mailing Address - Country:US
Mailing Address - Phone:803-957-8565
Mailing Address - Fax:803-957-9675
Practice Address - Street 1:205 COLUMBIA AVE
Practice Address - Street 2:C
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2662
Practice Address - Country:US
Practice Address - Phone:803-957-8565
Practice Address - Fax:803-957-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1235199381Medicare NSC
SC1720109622Medicare NSC
SC0675130004Medicare NSC
SC0675130000Medicare NSC
SC1811957962Medicare NSC
SC0675130003Medicare NSC
SCU-35567Medicare UPIN
SC1902927031Medicare NSC
SC5751Medicare PIN
SCU-37657Medicare UPIN
SC1922067610Medicare NSC
SC1114987260Medicare NSC
SC4365Medicare PIN
SC6900Medicare PIN
SCT-24397Medicare UPIN
SCT-81974Medicare UPIN
U-35567Medicare UPIN
SC1093836124Medicare NSC
SC1497714240Medicare NSC
SC0675130001Medicare NSC