Provider Demographics
NPI:1609900976
Name:ATLANTIC OPTICAL
Entity Type:Organization
Organization Name:ATLANTIC OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
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:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17772332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1277350001Medicare NSC