Provider Demographics
NPI:1336167279
Name:PITCAVAGE, JOSEPH M (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:PITCAVAGE
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:650 PAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3566
Mailing Address - Country:US
Mailing Address - Phone:843-870-4073
Mailing Address - Fax:
Practice Address - Street 1:730 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4053
Practice Address - Country:US
Practice Address - Phone:843-870-4073
Practice Address - Fax:843-471-2022
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13741Medicaid
SCAA12338435Medicare PIN
SCAA12338928Medicare PIN
SCAA12339057Medicare PIN
SCD13741Medicaid