MEDICARE: BART V DEPASCALE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1626	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180026432	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0459022	OTHER	OH	PTAN
3	SC02256830	OTHER	SC	PTAN

General Provider Information

NPI Number	:	1457357436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BART V DEPASCALE OD

Provider Business Mailing Address
First Line	:	10 WILLIAM POPE DR
Second Line	:	SUNGATE MEDICAL CENTER
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7549
Country	:	US
Telephone Number	:	843-842-2020
Fax Number	:	843-705-1512

Provider Business Practice Location Address
First Line	:	10 WILLIAM POPE DRIVE
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7459
Country	:	US
Telephone Number	:	843-842-2020
Fax Number	:	843-705-1512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/27/2023

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Directions to “ BART V DEPASCALE OD” Practice Location

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