Provider Demographics
NPI:1487665469
Name:CHARLESTON EYE CARE PA INC
Entity Type:Organization
Organization Name:CHARLESTON EYE CARE PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PA
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-762-7800
Mailing Address - Street 1:349 FOLLY RD
Mailing Address - Street 2:STE A1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2508
Mailing Address - Country:US
Mailing Address - Phone:843-762-7800
Mailing Address - Fax:843-762-7898
Practice Address - Street 1:349 FOLLY RD
Practice Address - Street 2:STE A1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2508
Practice Address - Country:US
Practice Address - Phone:843-762-7800
Practice Address - Fax:843-762-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC14854207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0694Medicaid
F45695Medicare UPIN
E456954340Medicare Oscar/Certification
SC4340Medicare PIN