NPIMap

Organization Active NPI

Professional Eyecare Corporation

  • Optometrist
  • Lake Wylie, SC
National Provider Identifier
1487880514
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1447 Issued in SC
Legal business name
PROFESSIONAL EYECARE CORPORATION
Practice address
439 Channel Rd
Ste 103
Lake Wylie, SC 29710-6102
Phone
(803) 746-7711
Fax
(803) 746-7189
NPI assigned
Jun 3, 2009
Last updated
Jul 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PROFESSIONAL EYECARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

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

Authorized official

Name
Dr. Monie Clifton, O.D.NPI 1801809454
Title
Optometrist
Phone
(803) 746-7711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1447 SC Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1448 SC

Addresses

Primary practice location

439 Channel Rd
Ste 103
Lake Wylie, SC 29710-6102

Mailing address

439 Channel Rd
Ste 103
Lake Wylie, SC 29710-6102
Phone (803) 746-7711

National Provider Directory

National Provider Directory
Part of
Professional Eyecare Corporation

Locations

439 Channel Rd
Ste 103
Lake Wylie, SC 29710
Phone (803) 743-7711

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1487880514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD",
            "address_2": "STE 103",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106102",
            "telephone_number": "803-746-7711",
            "fax_number": "803-746-7189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD",
            "address_2": "STE 103",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106102",
            "telephone_number": "803-746-7711",
            "fax_number": "803-746-7189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EYECARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL EYECARE CORPORATION",
        "enumeration_date": "2009-06-03",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "CLIFTON",
        "authorized_official_first_name": "MONIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "803-746-7711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1447",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wylie, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.