Provider Demographics
NPI:1760500524
Name:COASTAL EYE CARE OF DANIEL ISLAND
Entity Type:Organization
Organization Name:COASTAL EYE CARE OF DANIEL ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PITCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-471-2020
Mailing Address - Street 1:225 SEVEN FARMS DRIVE
Mailing Address - Street 2:105
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:843-471-2020
Mailing Address - Fax:843-471-2022
Practice Address - Street 1:225 SEVEN FARMS DRIVE
Practice Address - Street 2:105
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492
Practice Address - Country:US
Practice Address - Phone:843-471-2020
Practice Address - Fax:843-471-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty