Provider Demographics
NPI:1821219122
Name:EYECARE OPTICAL LLC
Entity Type:Organization
Organization Name:EYECARE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-722-0413
Mailing Address - Street 1:125 DOUGHTY STREET
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5740
Mailing Address - Country:US
Mailing Address - Phone:843-722-0413
Mailing Address - Fax:843-722-7149
Practice Address - Street 1:125 DOUGHTY STREET
Practice Address - Street 2:SUITE 330
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5740
Practice Address - Country:US
Practice Address - Phone:843-722-0413
Practice Address - Fax:843-722-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC072581156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID # RETAIL LICENSE
0622350001Medicare NSC