Provider Demographics
NPI:1174726210
Name:DRAISIN VISION GROUP PA
Entity type:Organization
Organization Name:DRAISIN VISION GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-556-2020
Mailing Address - Street 1:PO BOX 80817
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0817
Mailing Address - Country:US
Mailing Address - Phone:843-556-2020
Mailing Address - Fax:843-763-3937
Practice Address - Street 1:1470 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4707
Practice Address - Country:US
Practice Address - Phone:843-556-2020
Practice Address - Fax:843-763-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1413152W00000X, 152WC0802X, 152WL0500X
SC503152WC0802X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05037Medicaid
SC1548226822OtherNDRAISIN NPI #
SC1730305434OtherJ SMITH'S NPI #
SC1730305434OtherJ SMITH'S NPI #
SCV12150Medicare UPIN
SCD05037Medicaid
SCV12150Medicare UPIN
SCD05037Medicaid