Provider Demographics
NPI:1437108404
Name:PALMETTO EYE SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:PALMETTO EYE SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-842-2020
Mailing Address - Street 1:PO BOX 23018
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29925-3018
Mailing Address - Country:US
Mailing Address - Phone:843-785-2525
Mailing Address - Fax:843-785-5394
Practice Address - Street 1:220 PEMBROKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6200
Practice Address - Country:US
Practice Address - Phone:843-785-2525
Practice Address - Fax:843-785-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207N00000X, 207Q00000X, 207W00000X
SCHAS-507237700000X
GAHADS-872237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2666Medicaid
SCGP2666Medicaid