Provider Demographics
NPI:1467594408
Name:SKUFCA ENTERPRISES LLC
Entity Type:Organization
Organization Name:SKUFCA ENTERPRISES LLC
Other - Org Name:CAMDEN OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKUFCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-432-9874
Mailing Address - Street 1:615 LAURENS ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020
Mailing Address - Country:US
Mailing Address - Phone:803-432-6765
Mailing Address - Fax:803-432-8441
Practice Address - Street 1:615 LAURENS ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-6765
Practice Address - Fax:803-432-8441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC596152W00000X
SC26982207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC471678Medicaid
C61167Medicare UPIN
SC0256000001Medicare ID - Type Unspecified