Provider Demographics
NPI:1376284299
Name:LOOK OF SOUTH CAROLINA PA
Entity Type:Organization
Organization Name:LOOK OF SOUTH CAROLINA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CARLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-543-6333
Mailing Address - Street 1:710 HOPEWELL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7108
Mailing Address - Country:US
Mailing Address - Phone:843-543-6333
Mailing Address - Fax:
Practice Address - Street 1:710 HOPEWELL DR STE 106
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7108
Practice Address - Country:US
Practice Address - Phone:480-580-6671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2242OtherSTATE OF SOUTH CAROLINA