Provider Demographics
NPI:1679544530
Name:SAWYER, HENRY V JR (OD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:V
Last Name:SAWYER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO DRAWER 1149
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1149
Mailing Address - Country:US
Mailing Address - Phone:843-423-2091
Mailing Address - Fax:843-423-2093
Practice Address - Street 1:222 TOM GASQUE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-1149
Practice Address - Country:US
Practice Address - Phone:843-423-2091
Practice Address - Fax:843-423-2093
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD06198Medicaid
NC8909827Medicaid
SC410020931OtherRAILROAD MEDICARE
T24805Medicare UPIN
SC410020931OtherRAILROAD MEDICARE
SCT248052969Medicare ID - Type Unspecified