MEDICARE: DR. THOMAS EDWARD TALKIE O.D.

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	878	SC

General Provider Information

NPI Number	:	1558353409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS EDWARD TALKIE O.D.

Provider Business Mailing Address
First Line	:	5101 ASHLEY PHOSPHATE RD
Second Line	:	SUITE 112
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-2832
Country	:	US
Telephone Number	:	843-767-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 ASHLEY PHOSPHATE RD
Second Line	:	SUITE 112
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-2832
Country	:	US
Telephone Number	:	843-767-2328
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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