Provider Demographics
NPI:1982842308
Name:EYE CARE SPECIALTIES GROUP - WEST ASHLEY
Entity Type:Organization
Organization Name:EYE CARE SPECIALTIES GROUP - WEST ASHLEY
Other - Org Name:
Other - Org Type:
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 1:3531 MARY ADER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3531 MARY ADER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5896
Practice Address - Country:US
Practice Address - Phone:843-577-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE SPECIALTIES GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-22
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty