1316935885 NPI number — STOKES REGIONAL EYE CENTER

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 1316935885 NPI number — STOKES REGIONAL EYE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOKES REGIONAL EYE CENTER
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:
1316935885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-0534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-669-4156
Provider Business Mailing Address Fax Number:
843-664-0962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 N MATTHEWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29560-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-394-2476
Provider Business Practice Location Address Fax Number:
843-394-5789
Provider Enumeration Date:
10/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAKHOUR
Authorized Official First Name:
ISAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
843-669-4156

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP0999 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".