Healthcare Provider Details

I. General information

NPI: 1912959560
Provider Name (Legal Business Name): FLORENCE SURGERY & LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CASHUA DR
FLORENCE SC
29501
US

IV. Provider business mailing address

400 N CASHUA DR
FLORENCE SC
29501-2098
US

V. Phone/Fax

Practice location:
  • Phone: 843-664-2460
  • Fax: 843-664-2460
Mailing address:
  • Phone: 843-664-2460
  • Fax: 843-664-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number802523
License Number StateSC

VIII. Authorized Official

Name: DR. SAMUEL ERIC SELTZER
Title or Position: OWNER
Credential: MD
Phone: 843-664-9393