Healthcare Provider Details

I. General information

NPI: 1467639369
Provider Name (Legal Business Name): ISLAND EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 12/21/2012
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

Practice location:
  • Phone: 843-471-2733
  • Fax:
Mailing address:
  • Phone: 843-471-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1363
License Number StateSC

VIII. Authorized Official

Name: MR. GREG C TURNER
Title or Position: OFF MGR
Credential:
Phone: 843-471-2733