1790706927 NPI number — CAROLINA EYECARE PHYSICIANS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790706927 NPI number — CAROLINA EYECARE PHYSICIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EYECARE PHYSICIANS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790706927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2861 TRICOM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-9172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-797-5511
Provider Business Mailing Address Fax Number:
843-797-0638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
459 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTERBORO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29488-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-549-9500
Provider Business Practice Location Address Fax Number:
843-549-6885
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLYNN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
843-725-0064

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP2149 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com