Provider Demographics
NPI:1427227099
Name:CAROLINA CATARACT AND VISION CENTER
Entity Type:Organization
Organization Name:CAROLINA CATARACT AND VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-990-7590
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-0279
Mailing Address - Country:US
Mailing Address - Phone:843-797-3676
Mailing Address - Fax:843-797-3677
Practice Address - Street 1:137 GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3552
Practice Address - Country:US
Practice Address - Phone:843-797-3676
Practice Address - Fax:843-797-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21896207W00000X
SC18651207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1073562492OtherINDIVIDUAL NPI
SC1D218963Medicaid
SC1750393138OtherINDIVIDUAL NPI
SCP00371766OtherRAILROAD MEDICARE
SCP00371766OtherRAILROAD MEDICARE
SCH84424Medicare UPIN