Provider Demographics
NPI:1336440668
Name:LOWCOUNTRY EYE CARE OF GOOSE CREEK
Entity Type:Organization
Organization Name:LOWCOUNTRY EYE CARE OF GOOSE CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-763-2270
Mailing Address - Street 1:425 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-4505
Mailing Address - Country:US
Mailing Address - Phone:843-763-2270
Mailing Address - Fax:
Practice Address - Street 1:425 RED BANK RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-4505
Practice Address - Country:US
Practice Address - Phone:843-797-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA EYE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-03
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9624Medicare UPIN