Provider Demographics
NPI:1225227226
Name:BROOKS, ROBERT C (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1606 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3216
Mailing Address - Country:US
Mailing Address - Phone:843-795-3937
Mailing Address - Fax:843-795-4760
Practice Address - Street 1:1606 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3216
Practice Address - Country:US
Practice Address - Phone:843-795-3937
Practice Address - Fax:843-795-4760
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09015Medicaid
SCU05482Medicare UPIN
SCD09015Medicaid