Provider Demographics
NPI:1487641460
Name:LOW COUNTRY EYE CARE INC
Entity Type:Organization
Organization Name:LOW COUNTRY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:843-763-2270
Mailing Address - Street 1:PO BOX 30201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0201
Mailing Address - Country:US
Mailing Address - Phone:843-763-2270
Mailing Address - Fax:843-763-7337
Practice Address - Street 1:801 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7147
Practice Address - Country:US
Practice Address - Phone:843-763-2270
Practice Address - Fax:843-763-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09845Medicaid
DA9845OtherGROUP