Healthcare Provider Details

I. General information

NPI: 1356525273
Provider Name (Legal Business Name): PALMETTO VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 W ASHLEY CIR
CHARLESTON SC
29414-9156
US

IV. Provider business mailing address

PO BOX 80249
CHARLESTON SC
29416-0249
US

V. Phone/Fax

Practice location:
  • Phone: 843-852-0075
  • Fax: 843-852-0600
Mailing address:
  • Phone: 843-852-0075
  • Fax: 843-852-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1166
License Number StateSC

VIII. Authorized Official

Name: ROBERT AITKEN
Title or Position: OWNER
Credential: OD
Phone: 843-852-0075