Provider Demographics
NPI:1245384726
Name:PALMETTO EYECARE, P.A.
Entity Type:Organization
Organization Name:PALMETTO EYECARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-388-2020
Mailing Address - Street 1:1001 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3230
Mailing Address - Country:US
Mailing Address - Phone:864-388-2020
Mailing Address - Fax:864-229-5573
Practice Address - Street 1:1001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3230
Practice Address - Country:US
Practice Address - Phone:864-388-2020
Practice Address - Fax:864-229-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9913Medicaid
SC=========OtherFEDERAL ID
SC=========OtherFEDERAL ID
SC0584580001Medicare NSC