NPIMap

Organization Active NPI

Pee Dee Eye Associates, PA

  • Optometrist
  • Sumter, SC
National Provider Identifier
1861894115
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1422 Issued in SC
Legal business name
PEE DEE EYE ASSOCIATES, PA
Practice address
528 Broad St
Ste 101
Sumter, SC 29150-3368
Phone
(803) 775-1772
Fax
(803) 775-4729
NPI assigned
Sep 18, 2014
Last updated
Sep 18, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
PEE DEE EYE ASSOCIATES, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Authorized official

Name
Mrs. Ann Rush
Title
Office Manager
Phone
(843) 332-7171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1422 SC Primary

Addresses

Primary practice location

528 Broad St
Ste 101
Sumter, SC 29150-3368

Mailing address

PO Box 1956
Hartsville, SC 29551-1956
Phone (803) 775-1772

Other identifiers 3

IdentifierTypeStateIssuer
D13340MedicaidSC
D04546MedicaidSC
459665MedicaidSC

National Provider Directory

National Provider Directory
Part of
Pee Dee Eye Associates

Locations

602 E Main St
Bennettsville, SC 29512
Phone (843) 473-2020

528 Broad St
Ste 101
Sumter, SC 29150
Phone (803) 720-9151

Practitioners & affiliated clinicians

Practitioners 7

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": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1861894115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1956",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511956",
            "telephone_number": "803-775-1772",
            "fax_number": "803-775-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 BROAD ST",
            "address_2": "STE 101",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291503368",
            "telephone_number": "803-775-1772",
            "fax_number": "803-775-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEE DEE EYE ASSOCIATES, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEE DEE EYE ASSOCIATES, PA",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "843-332-7171",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D13340",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D04546",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "459665",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.