Provider Demographics
NPI:1467595074
Name:EYECARE PHYSICIANS & SURGEONS LLC
Entity Type:Organization
Organization Name:EYECARE PHYSICIANS & SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:COA, CMA
Authorized Official - Phone:843-722-7705
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-722-7705
Mailing Address - Fax:843-722-7149
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 330
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-722-7705
Practice Address - Fax:843-722-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1975Medicaid
SCF18021Medicare UPIN
SCF25282Medicare UPIN
SCGP1975Medicaid