Provider Demographics
NPI:1407252307
Name:OPTIC GALLERY, LLC
Entity Type:Organization
Organization Name:OPTIC GALLERY, LLC
Other - Org Name:OPTIC GALLERY FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-424-9099
Mailing Address - Street 1:4036 RIVER OAKS DR
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6695
Mailing Address - Country:US
Mailing Address - Phone:843-236-2500
Mailing Address - Fax:843-236-2575
Practice Address - Street 1:4036 RIVER OAKS DR
Practice Address - Street 2:SUITE B-8
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6695
Practice Address - Country:US
Practice Address - Phone:843-236-2500
Practice Address - Fax:843-236-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty