Anderson Ophthalmology PC
Organization Active NPI Ophthalmology Physician · Anderson, SC
NPI 1245446392 · NPPES record last updated Jan 23, 2025
Key facts
- NPI
- 1245446392
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- ANDERSON OPHTHALMOLOGY PC
- Practice address
- 1116 Cornelia Rd
Anderson, SC 29622 - Phone
- (864) 224-0028
- Fax
- (864) 225-5067
- NPI assigned
- May 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Boris Ilg, MD
- Title
- President
- Phone
- (864) 224-0028
Practitioners 3
-
Boris A Ilg, MD
-
Nita Saini, O.D.
-
Edward C Mattison, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100415000418 | SC | Part B Supplier - Clinic/Group Practice | 9436286903 |
Receives reassigned benefits from 2 practitioners Practice locations: Anderson, SC |
| O20100930074019 | SC | DME Supplier - Physician - Ophthalmology |
9436286903 | Practice locations: Anderson, SC |
National Provider Directory
Locations
1655 E Greenville St
Anderson, SC 29621
Phone (803) 224-6375
1116 Cornelia Rd
Anderson, SC 29621
Phone (864) 224-0028
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
1116 Cornelia Rd
Anderson, SC 29622
Mailing address
1116 Cornelia Rd
Anderson, SC 29621-3317
Phone (864) 224-0028
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 049557 | Medicaid | SC |
Other providers in Anderson, SC
- Anderson Home Care LLC
- Anderson Neurological Associates
- Anderson Oconee Behavioral Health Services
- Anderson Oconee Council on Teen Pregnancy Prevention
- Anderson Oncology-Hematology Clinic PA
- Anderson Optometric Associates
- Anderson Oral and Maxillofacial Surgery, PA
- Anderson Orthodontic Associates PA
- Anderson Pastoral Counseling & Consultation Service
- Anderson Pediatric Dentistry
All providers in Anderson, SC · Ophthalmology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.