Provider Demographics
NPI:1134980899
Name:ISLE OF PALMS EYE ASSOCIATES
Entity type:Organization
Organization Name:ISLE OF PALMS EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-360-3966
Mailing Address - Street 1:9410 COVE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5002
Mailing Address - Country:US
Mailing Address - Phone:740-360-3966
Mailing Address - Fax:
Practice Address - Street 1:1708 TOWNE CENTRE WAY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2300
Practice Address - Country:US
Practice Address - Phone:846-972-6249
Practice Address - Fax:843-856-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty