Provider Demographics
NPI:1841597408
Name:PRIMARY CARE OPTOMETRY
Entity Type:Organization
Organization Name:PRIMARY CARE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-881-2525
Mailing Address - Street 1:855 HOUSTON NORTHCUTT BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3446
Mailing Address - Country:US
Mailing Address - Phone:843-881-2525
Mailing Address - Fax:843-881-2578
Practice Address - Street 1:855 HOUSTON NORTHCUTT BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3446
Practice Address - Country:US
Practice Address - Phone:843-881-2525
Practice Address - Fax:843-881-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC739332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier