Provider Demographics
NPI:1932370202
Name:BLUFFTON TOTAL EYE CARE
Entity Type:Organization
Organization Name:BLUFFTON TOTAL EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-706-3022
Mailing Address - Street 1:80 BAYLOR DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8902
Mailing Address - Country:US
Mailing Address - Phone:843-706-3022
Mailing Address - Fax:
Practice Address - Street 1:80 BAYLOR DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8902
Practice Address - Country:US
Practice Address - Phone:843-706-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC741332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4886560001Medicare NSC