Provider Demographics
NPI:1912038704
Name:FLOWERTOWN FAMILY VISION CARE, LLC
Entity Type:Organization
Organization Name:FLOWERTOWN FAMILY VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-832-4520
Mailing Address - Street 1:105 S CEDAR ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6078
Mailing Address - Country:US
Mailing Address - Phone:843-832-4520
Mailing Address - Fax:843-871-2269
Practice Address - Street 1:105 S. CEDAR ST.
Practice Address - Street 2:SUITE F
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6078
Practice Address - Country:US
Practice Address - Phone:843-832-4520
Practice Address - Fax:843-871-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10110Medicaid