Healthcare Provider Details

I. General information

NPI: 1205031234
Provider Name (Legal Business Name): THE RETINA CENTER OF CHARLESTON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 CHARLIE HALL BLVD SUITE A
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

2057 CHARLIE HALL BLVD SUITE A
CHARLESTON SC
29414-5834
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-6491
  • Fax: 843-763-6371
Mailing address:
  • Phone: 843-763-6491
  • Fax: 843-763-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number11997
License Number StateSC

VIII. Authorized Official

Name: DR. LOWREY PEARSON KING
Title or Position: PHYSICIAN,OWNER
Credential: MD
Phone: 843-763-6491