Provider Demographics
NPI:1952598757
Name:CAROLINA CATARACT CLINIC
Entity Type:Organization
Organization Name:CAROLINA CATARACT CLINIC
Other - Org Name:ADVANTAGE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-788-2276
Mailing Address - Street 1:PO BOX 23098
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3098
Mailing Address - Country:US
Mailing Address - Phone:803-775-0203
Mailing Address - Fax:803-788-1022
Practice Address - Street 1:214 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4102
Practice Address - Country:US
Practice Address - Phone:803-775-0203
Practice Address - Fax:803-788-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2754Medicaid
SC6589Medicare PIN
SCGP2754Medicaid