Healthcare Provider Details

I. General information

NPI: 1093878001
Provider Name (Legal Business Name): ROBERT LOPANIK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 RUTLEDGE AVE
CHARLESTON SC
29401-1333
US

IV. Provider business mailing address

112 RUTLEDGE AVE
CHARLESTON SC
29401-1333
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-2674
  • Fax: 843-577-5170
Mailing address:
  • Phone: 843-577-2674
  • Fax: 843-577-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number537
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number537
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number537
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: