Healthcare Provider Details

I. General information

NPI: 1710172176
Provider Name (Legal Business Name): WISE VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 RIBAUT RD
BEAUFORT SC
29902-6143
US

IV. Provider business mailing address

1270 RIBAUT RD
BEAUFORT SC
29902-6143
US

V. Phone/Fax

Practice location:
  • Phone: 843-525-9473
  • Fax: 843-525-1108
Mailing address:
  • Phone: 843-525-9473
  • Fax: 843-525-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1031
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1051
License Number StateSC

VIII. Authorized Official

Name: DR. WARREN PAUL WISE
Title or Position: OD
Credential:
Phone: 843-525-9473