Provider Demographics
NPI:1114099553
Name:CAROLINA EYE AND EAR ASSOCIATES LLC
Entity Type:Organization
Organization Name:CAROLINA EYE AND EAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-744-4103
Mailing Address - Street 1:2016 SUMTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2100
Mailing Address - Country:US
Mailing Address - Phone:803-744-2700
Mailing Address - Fax:803-744-7979
Practice Address - Street 1:2016 SUMTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2100
Practice Address - Country:US
Practice Address - Phone:803-744-2700
Practice Address - Fax:803-744-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0689474207W00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAXID FOR COMMERCIAL INS