NPIMap

Organization Active NPI

Marlboro Eye Care Associates, LLC

  • Optometrist
  • Bennettsville, SC
National Provider Identifier
1669509980
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1222 Issued in SC
Legal business name
MARLBORO EYE CARE ASSOCIATES, LLC
Practice address
602 E Main St
Bennettsville, SC 29512-3218
Phone
(843) 479-2020
Fax
(843) 454-2020
NPI assigned
Feb 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Authorized official

Name
Dr. David Scott Johnson, O.D.
Title
Proprietor
Phone
(843) 479-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1222 SC Primary

Addresses

Primary practice location

602 E Main St
Bennettsville, SC 29512-3218

Mailing address

PO Box 1094
Bennettsville, SC 29512-1094
Phone (843) 479-2020

Other identifiers 1

IdentifierTypeStateIssuer
DA9664MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1669509980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1094",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295121094",
            "telephone_number": "843-479-2020",
            "fax_number": "843-454-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 E MAIN ST",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295123218",
            "telephone_number": "843-479-2020",
            "fax_number": "843-454-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBORO EYE CARE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "843-479-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9664",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennettsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; 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.