Provider Demographics
NPI:1679714000
Name:PRECISION EYECARE INC.
Entity Type:Organization
Organization Name:PRECISION EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:WHITTREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-425-3757
Mailing Address - Street 1:1411 CROSS BILL TRL
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8231
Mailing Address - Country:US
Mailing Address - Phone:843-425-3757
Mailing Address - Fax:
Practice Address - Street 1:1801 S ST RD 57
Practice Address - Street 2:WAL-MART OPTICAL
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4326
Practice Address - Country:US
Practice Address - Phone:812-254-6894
Practice Address - Fax:812-254-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-15
Last Update Date:2009-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003558A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty