Healthcare Provider Details

I. General information

NPI: 1124198668
Provider Name (Legal Business Name): BELFAIR EYE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OAK FOREST RD STE A
BLUFFTON SC
29910-4990
US

IV. Provider business mailing address

18 OAK FOREST RD STE A
BLUFFTON SC
29910-4990
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-3415
  • Fax: 843-815-3417
Mailing address:
  • Phone: 843-815-3415
  • Fax: 843-815-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1332
License Number StateSC

VIII. Authorized Official

Name: DR. DEBORAH MARIE AMOROSO
Title or Position: MANAGING MEMBER
Credential: O.D.
Phone: 843-815-3415