Healthcare Provider Details

I. General information

NPI: 1467595074
Provider Name (Legal Business Name): EYECARE PHYSICIANS & SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST SUITE 330
CHARLESTON SC
29403-5736
US

IV. Provider business mailing address

125 DOUGHTY ST SUITE 330
CHARLESTON SC
29403-5736
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-7705
  • Fax: 843-722-7149
Mailing address:
  • Phone: 843-722-7705
  • Fax: 843-722-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELYN P HALL
Title or Position: PRACTICE MANAGER
Credential: COA, CMA
Phone: 843-722-7705