NPIMap

Organization Active NPI

Aeg South Carolina Professional PC

  • Optometrist
  • Columbia, SC
National Provider Identifier
1720768427
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG SOUTH CAROLINA PROFESSIONAL PC
Practice address
121 Lucy LN
Columbia, SC 29229-7835
Phone
(803) 217-2550
NPI assigned
Jul 19, 2023
Last updated
May 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Authorized official

Name
Melissa K Allison
Title
Sr. Dir. RCM/MVC
Phone
(618) 462-9818

Specialties & licenses 1

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

Addresses

Primary practice location

121 Lucy LN
Columbia, SC 29229-7835

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230918000311 SC Part B Supplier - Clinic/Group Practice 5597129064 Receives reassigned benefits from 19 practitioners
Practice locations: Columbia, SC; Simpsonville, SC; Myrtle Beach, SC; Lexington, SC; Greenville, SC

National Provider Directory

National Provider Directory

Locations

121 Lucy Ln
Columbia, SC 29229
Phone (803) 217-2550

275 Harbison Blvd
Columbia, SC 29212
Phone (803) 781-2071

644 N Main St
Ste 109
Greenville, SC 29601
Phone (864) 900-0671

205 Columbia Ave
Lexington, SC 29072
Phone (803) 957-8565

3874 Renee Dr
Unit D
Myrtle Beach, SC 29579
Phone (843) 903-4500

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1720768427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 LUCY LN",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292297835",
            "telephone_number": "803-217-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG SOUTH CAROLINA PROFESSIONAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SR. DIR. RCM/MVC",
        "authorized_official_telephone_number": "618-462-9818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.