Provider Demographics
NPI:1760722482
Name:LOWCOUNTRY VISION CARE, LLC
Entity Type:Organization
Organization Name:LOWCOUNTRY VISION CARE, LLC
Other - Org Name:CHARLESTON EYEWEAR GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-235-2536
Mailing Address - Street 1:91 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2272
Mailing Address - Country:US
Mailing Address - Phone:843-727-0080
Mailing Address - Fax:
Practice Address - Street 1:91 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2272
Practice Address - Country:US
Practice Address - Phone:843-727-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWCOUNTRY VISION CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT83743Medicare PIN