Provider Demographics
NPI:1861631343
Name:EYE CARE SPECIALTIES GROUP - KIAWAH
Entity Type:Organization
Organization Name:EYE CARE SPECIALTIES GROUP - KIAWAH
Other - Org Name:VILLAGE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MORABITO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-557-2865
Mailing Address - Street 1:130 GARDNERS CIR
Mailing Address - Street 2:PMB 159
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-5467
Mailing Address - Country:US
Mailing Address - Phone:843-768-0565
Mailing Address - Fax:
Practice Address - Street 1:130 GARDNERS CIR
Practice Address - Street 2:PMB 159
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-5467
Practice Address - Country:US
Practice Address - Phone:843-768-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE SPECIALTIES GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty