Provider Demographics
NPI:1134364128
Name:PALMETTO EYECARE ASSOCIATES P A
Entity type:Organization
Organization Name:PALMETTO EYECARE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-985-2020
Mailing Address - Street 1:2460 INDIA HOOK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3530
Mailing Address - Country:US
Mailing Address - Phone:803-985-2020
Mailing Address - Fax:803-985-2021
Practice Address - Street 1:2460 INDIA HOOK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3530
Practice Address - Country:US
Practice Address - Phone:803-985-2020
Practice Address - Fax:803-985-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9667Medicare PIN