Provider Demographics
NPI:1649342205
Name:DUBIN OPTOMETRIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DUBIN OPTOMETRIC ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-549-2015
Mailing Address - Street 1:201 EDDIE CHASTEEN DR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-5728
Mailing Address - Country:US
Mailing Address - Phone:843-549-2015
Mailing Address - Fax:843-549-0104
Practice Address - Street 1:201 EDDIE CHASTEEN DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5728
Practice Address - Country:US
Practice Address - Phone:843-549-2015
Practice Address - Fax:843-549-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO9257Medicaid
SC0164190001Medicare NSC
SC4800Medicare PIN