Provider Demographics
NPI:1881996346
Name:CAROLINA EYE SERVICES, LLC
Entity type:Organization
Organization Name:CAROLINA EYE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORRIS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PHILBECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-884-9490
Mailing Address - Street 1:1280 APPLING DR
Mailing Address - Street 2:#303
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7620
Practice Address - Country:US
Practice Address - Phone:843-884-9490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9610Medicaid
SCA414Medicare UPIN