Provider Demographics
NPI:1205031234
Name:THE RETINA CENTER OF CHARLESTON, PA
Entity Type:Organization
Organization Name:THE RETINA CENTER OF CHARLESTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWREY
Authorized Official - Middle Name:PEARSON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-763-6491
Mailing Address - Street 1:2057 CHARLIE HALL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5834
Mailing Address - Country:US
Mailing Address - Phone:843-763-6491
Mailing Address - Fax:843-763-6371
Practice Address - Street 1:2057 CHARLIE HALL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5834
Practice Address - Country:US
Practice Address - Phone:843-763-6491
Practice Address - Fax:843-763-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11997261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119972Medicaid
SC119972Medicaid
SC7728Medicare PIN