Healthcare Provider Details

I. General information

NPI: 1457357436
Provider Name (Legal Business Name): BART V DEPASCALE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/27/2023
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILLIAM POPE DRIVE
BLUFFTON SC
29909-7459
US

IV. Provider business mailing address

10 WILLIAM POPE DR SUNGATE MEDICAL CENTER
BLUFFTON SC
29909-7549
US

V. Phone/Fax

Practice location:
  • Phone: 843-842-2020
  • Fax: 843-705-1512
Mailing address:
  • Phone: 843-842-2020
  • Fax: 843-705-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1626
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: