Healthcare Provider Details

I. General information

NPI: 1861803520
Provider Name (Legal Business Name): EYES OVER CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S 4TH ST
HARTSVILLE SC
29550-0705
US

IV. Provider business mailing address

356 WOODLANDER DR
BLYTHEWOOD SC
29016-7621
US

V. Phone/Fax

Practice location:
  • Phone: 843-857-1999
  • Fax: 803-227-8996
Mailing address:
  • Phone: 803-776-5363
  • Fax: 803-227-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1696
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1696
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1696
License Number StateSC

VIII. Authorized Official

Name: DR. EDWIN KYLE MITCHELL
Title or Position: OWNER
Credential: OD
Phone: 336-707-6542