Healthcare Provider Details

I. General information

NPI: 1285616037
Provider Name (Legal Business Name): CAROLINA CATARACT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ATRIUM WAY SUITE 120
COLUMBIA SC
29223
US

IV. Provider business mailing address

PO BOX 23098
COLUMBIA SC
29224-3098
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-2276
  • Fax: 803-788-1022
Mailing address:
  • Phone: 803-788-2276
  • Fax: 803-788-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DEAN ROBERT JACOBS
Title or Position: OWNER
Credential: MD
Phone: 803-788-2276