Provider Demographics
NPI:1275634362
Name:BOHAC, PAUL W (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:BOHAC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457-0874
Mailing Address - Country:US
Mailing Address - Phone:843-559-5333
Mailing Address - Fax:843-559-5339
Practice Address - Street 1:2875 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4808
Practice Address - Country:US
Practice Address - Phone:843-559-5333
Practice Address - Fax:843-559-5339
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9762Medicaid
SCDO9070Medicaid
SC410049665Medicare ID - Type UnspecifiedRR MEDICARE
SCDA9762Medicaid
SCT931727306Medicare ID - Type UnspecifiedMEDICARE