Healthcare Provider Details

I. General information

NPI: 1679739908
Provider Name (Legal Business Name): CHARLESTON VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 FOLLY RD SUITE 1A
CHARLESTON SC
29412-2508
US

IV. Provider business mailing address

349 FOLLY RD SUITE 1A
CHARLESTON SC
29412-2508
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-7917
  • Fax: 843-762-7898
Mailing address:
  • Phone: 843-795-7917
  • Fax: 843-762-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD ALAN HARBERT
Title or Position: OPTICIAN/OWNER
Credential:
Phone: 843-795-7917