Healthcare Provider Details

I. General information

NPI: 1487631867
Provider Name (Legal Business Name): EYECARE SPECIALTIES OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 MARY ADER AVE STE B
CHARLESTON SC
29414-5896
US

IV. Provider business mailing address

3531 MARY ADER AVE STE B
CHARLESTON SC
29414-5896
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-2047
  • Fax:
Mailing address:
  • Phone: 843-577-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KIM FAULKNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-577-2047