Healthcare Provider Details

I. General information

NPI: 1053385062
Provider Name (Legal Business Name): LUCAS OLIVER PLATT JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHIP PLATT

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BERNARDIN AVE. STE 100
COLUMBIA SC
29204-2039
US

IV. Provider business mailing address

1655 BERNARDIN AVE. STE 100
COLUMBIA SC
29204-2039
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-0641
  • Fax: 803-779-3649
Mailing address:
  • Phone: 803-256-0641
  • Fax: 803-779-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE-1470
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMDO.1619DO
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: