Scott, Gordon Quatlebaum

Scott, Gordon Quatlebaum is an individual health care provider with primary practice located at 1812 Washington St , Columbia SC 29201-3549. He recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as his primary health care specialty. Scott, Gordon Quatlebaum can be contacted via phone (803) 254-9381.

Contact Information

Primary practice address
1812 Washington St Columbia SC 29201-3549
Phone: (803) 254-9381
Fax: (803) 254-1978
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X 352 South Carolina

Profile Details

NPI number 1447387048
LBN Legal business name Scott, Gordon Quatlebaum
Credentials OPTICIAN
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447387048 NPPES
South Carolina MEDICAID DV0105

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