Eyes on the Lake LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1597 Issued in SC

Legal business name

EYES ON THE LAKE LLC

Practice address

2914 Dreher Shoals Rd Ste a
Columbia, SC 29212-7909

Phone

(803) 575-0723

NPI assigned

Apr 2, 2018

Last updated

Jul 27, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Daniels, ODNPI 1962797357

Title

Owner/Optometrist

Phone

(727) 804-3063

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Daniels, O.D.

  • Optometrist
  • Columbia, SC
  • NPI 1962797357
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1316443146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2914 DREHER SHOALS RD STE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292127909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2914 DREHER SHOALS RD STE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292127909",
            "telephone_number": "803-575-0723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYES ON THE LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-02",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "727-804-3063",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Physicians and Surgeons of Columbia
• Eyemart Express
• Eyemart Express LLC
• Eyemart Express LLC
• Eyemart Express LTD
• Eyes-on-Wheels
• Eyewear Inc (Folline Vision Center 3)
• Karen Ezenne, M.D.
• Ezra Health Services, LLC
• Ariel Margaret Ezzo, MD

• Optometrist in Columbia, SC
• Providers in Columbia, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.