Optique
Organization Active NPI Optometrist · Fort Mill, SC
NPI 1891048872 · NPPES record last updated Jul 16, 2014
Key facts
- NPI
- 1891048872
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- OPTIQUE
- Practice address
- 1510 Onyx Ridge Rd
Suite 101
Fort Mill, SC 29708 - Phone
- (803) 802-3937
- NPI assigned
- Oct 16, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Nickolas Vastis, O.D.
- Title
- President
- Phone
- (803) 409-8333
Practitioners 2
-
Nickolas Andrew Vastis, O.D.
-
Brook A Vastis, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130221000063 | SC | Part B Supplier - Clinic/Group Practice | 3072768183 |
Receives reassigned benefits from 2 practitioners Practice locations: Fort Mill, SC |
National Provider Directory
Locations
1510 Onyx Rdg
Ste 101
Fort Mill, SC 29708
Phone (803) 409-8332
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | SC | Yes |
Addresses
Primary practice location
1510 Onyx Ridge Rd
Suite 101
Fort Mill, SC 29708
Mailing address
1510 Onyx Ridge
Suite 101
Fort Mill, SC 29708
Phone (803) 802-3937
Other providers in Fort Mill, SC
- Sharon Olang
- Olive Oak Family Services, LLC
- Kimberly Oltman
- Om Sai RX LLC.
- Omnidrip
- Ebele Gwendolyn Orazulike
- Bridgette Orehek
- Original Design Builders
- Julia Lynn Ormsby
- Ortho Sport & Spine Physicians Fort Mill
All providers in Fort Mill, SC · Optometrist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.