Provider Demographics
NPI:1477520641
Name:ATLANTIC OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:ATLANTIC OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-2888
Mailing Address - Street 1:1094 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5437
Mailing Address - Country:US
Mailing Address - Phone:843-524-2888
Mailing Address - Fax:843-524-9328
Practice Address - Street 1:1094 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5437
Practice Address - Country:US
Practice Address - Phone:843-524-2888
Practice Address - Fax:843-524-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC180024498OtherRAIL ROAD MEDICARE #
SCGP2689Medicaid
SCT12108Medicaid
SCCC2519OtherRAIL ROAD MEDICARE GP#
SCGP1358Medicaid
SCGP1358Medicaid
SCT12108Medicaid
SCGP2689Medicaid