Provider Demographics
NPI:1568198539
Name:FORQUER, CAITLIN LOUISE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LOUISE
Last Name:FORQUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:LOUISE
Other - Last Name:FORQUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 D E CLARK RD
Mailing Address - Street 2:
Mailing Address - City:PELION
Mailing Address - State:SC
Mailing Address - Zip Code:29123-9425
Mailing Address - Country:US
Mailing Address - Phone:803-369-0157
Mailing Address - Fax:
Practice Address - Street 1:10060 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4396
Practice Address - Country:US
Practice Address - Phone:803-419-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC246905156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician