Provider Demographics
NPI:1831463652
Name:MEDEYECARE, LLC
Entity Type:Organization
Organization Name:MEDEYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:843-655-2299
Mailing Address - Street 1:4335 SOCASTEE BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-655-2299
Mailing Address - Fax:
Practice Address - Street 1:4335 SOCASTEE BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:843-655-2299
Practice Address - Fax:843-831-0481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC026666224156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty