Provider Demographics
NPI:1790848455
Name:PERKINS EYECARE LLC
Entity Type:Organization
Organization Name:PERKINS EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:IRIC
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-482-0028
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-1588
Mailing Address - Country:US
Mailing Address - Phone:843-482-0028
Mailing Address - Fax:843-899-5875
Practice Address - Street 1:511 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3132
Practice Address - Country:US
Practice Address - Phone:843-482-0028
Practice Address - Fax:843-899-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50-1392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8658Medicare PIN