Provider Demographics
NPI:1508269093
Name:PEDIATRIC EYE CARE & STRABISMUS, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC EYE CARE & STRABISMUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:BOOHER
Authorized Official - Last Name:GOSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-236-3339
Mailing Address - Street 1:1674 CRANIUM DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3567
Mailing Address - Country:US
Mailing Address - Phone:803-327-3937
Mailing Address - Fax:803-792-0545
Practice Address - Street 1:1674 CRANIUM DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3567
Practice Address - Country:US
Practice Address - Phone:803-327-3937
Practice Address - Fax:803-792-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936361Medicaid
NC1295783223OtherINDIVIDUAL NATIONAL PROVIDER IDENTIFICATION
SCNT5996Medicaid
NCE84302Medicare UPIN