Provider Demographics
NPI:1689831521
Name:PALMETTO EYE SPECIALISTS-OPTOMETRISTS
Entity Type:Organization
Organization Name:PALMETTO EYE SPECIALISTS-OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-785-5398
Mailing Address - Street 1:220 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6200
Mailing Address - Country:US
Mailing Address - Phone:843-785-5398
Mailing Address - Fax:843-785-5394
Practice Address - Street 1:220 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-6200
Practice Address - Country:US
Practice Address - Phone:843-785-5398
Practice Address - Fax:843-785-5394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO EYE SPECIALISTS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13326Medicaid
SCD14624Medicaid
SCGP2666Medicaid