Healthcare Provider Details

I. General information

NPI: 1932511193
Provider Name (Legal Business Name): AMEDCO SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 MYRTLE TRACE DR
CONWAY SC
29526-8945
US

IV. Provider business mailing address

3911 A HIGHWAY 17 BYPASS
MURRELLS INLET SC
29576-5014
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-7236
  • Fax: 843-347-7238
Mailing address:
  • Phone: 843-651-8200
  • Fax: 843-651-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ERICA PERREIRA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 877-881-0022