Provider Demographics
NPI:1457357436
Name:DEPASCALE, BART V (OD)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:V
Last Name:DEPASCALE
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 1:10 WILLIAM POPE DR
Mailing Address - Street 2:SUNGATE MEDICAL CENTER
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7549
Mailing Address - Country:US
Mailing Address - Phone:843-842-2020
Mailing Address - Fax:843-705-1512
Practice Address - Street 1:10 WILLIAM POPE DRIVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7459
Practice Address - Country:US
Practice Address - Phone:843-842-2020
Practice Address - Fax:843-705-1512
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1626152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180026432OtherRAILROAD MEDICARE
OH0459022OtherPTAN
SCSC02256830OtherPTAN
SCSC02256830OtherPTAN