Provider Demographics
NPI:1013007210
Name:EYE SITE LLC
Entity type:Organization
Organization Name:EYE SITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYPCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-681-3396
Mailing Address - Street 1:16 CHARLESFORT PL
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1988
Mailing Address - Country:US
Mailing Address - Phone:843-540-2327
Mailing Address - Fax:843-681-8734
Practice Address - Street 1:25 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2259
Practice Address - Country:US
Practice Address - Phone:843-681-3396
Practice Address - Fax:843-681-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8320Medicare PIN