Healthcare Provider Details
I. General information
NPI: 1235378712
Provider Name (Legal Business Name): EYE CARE SPECIALTIES GROUP - DANIEL ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
250 SEVEN FARMS DR SUITE A
DANIEL ISLAND SC
29492-8159
US
IV. Provider business mailing address
250 SEVEN FARMS DR SUITE A
DANIEL ISLAND SC
29492-8159
US
V. Phone/Fax
- Phone: 843-471-2733
- Fax:
- Phone: 843-471-2733
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
MICHAEL
Z
MORABITO
Title or Position: MANAGER
Credential: O.D.
Phone: 843-557-2865