Healthcare Provider Details

I. General information

NPI: 1700361805
Provider Name (Legal Business Name): KARA PLANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N FRASER ST
GEORGETOWN SC
29440-2800
US

IV. Provider business mailing address

223 SOUTHGATE CT
PAWLEYS ISLAND SC
29585-4407
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8946
  • Fax:
Mailing address:
  • Phone: 215-516-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: