Provider Demographics
NPI:1881738862
Name:CAUGH EYE CARE
Entity type:Organization
Organization Name:CAUGH EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-281-8181
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0761
Mailing Address - Country:US
Mailing Address - Phone:843-281-8181
Mailing Address - Fax:843-281-9009
Practice Address - Street 1:550 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2904
Practice Address - Country:US
Practice Address - Phone:843-281-8181
Practice Address - Fax:843-281-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9738Medicaid
SCDA9738Medicaid