Provider Demographics
NPI:1275651382
Name:EAST COAST OPTOMETRIC, INC.
Entity Type:Organization
Organization Name:EAST COAST OPTOMETRIC, INC.
Other - Org Name:(DBA) H. RUBIN VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-788-8204
Mailing Address - Street 1:7539 GARNERS FERRY RD.
Mailing Address - Street 2:EAST COAST OPTOMETRIC, INC.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209
Mailing Address - Country:US
Mailing Address - Phone:803-779-9313
Mailing Address - Fax:803-779-9551
Practice Address - Street 1:130 FORUM DR. SUITE 12
Practice Address - Street 2:H. RUBIN VISION CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:803-788-8204
Practice Address - Fax:803-788-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1431152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty