Provider Demographics
NPI:1346267945
Name:MT PLEASANT OPHTHALMOLOGY
Entity Type:Organization
Organization Name:MT PLEASANT OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-2015
Mailing Address - Street 1:1705 BEAUCASTEL RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3657
Mailing Address - Country:US
Mailing Address - Phone:843-884-2015
Mailing Address - Fax:843-881-7068
Practice Address - Street 1:1705 BEAUCASTEL RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3657
Practice Address - Country:US
Practice Address - Phone:843-884-2015
Practice Address - Fax:843-881-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3030Medicaid
6974Medicare ID - Type Unspecified