Provider Demographics
NPI:1932247368
Name:DR.C'S EYE CARE,LLC
Entity Type:Organization
Organization Name:DR.C'S EYE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-436-2020
Mailing Address - Street 1:915 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2803
Mailing Address - Country:US
Mailing Address - Phone:843-436-2020
Mailing Address - Fax:843-546-0506
Practice Address - Street 1:915 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2803
Practice Address - Country:US
Practice Address - Phone:843-436-2020
Practice Address - Fax:843-546-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO9480Medicaid
SCDO9480Medicaid