Healthcare Provider Details

I. General information

NPI: 1437108404
Provider Name (Legal Business Name): PALMETTO EYE SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 PEMBROKE DR SUITE 100
HILTON HEAD ISLAND SC
29926-6200
US

IV. Provider business mailing address

PO BOX 23018
HILTON HEAD ISLAND SC
29925-3018
US

V. Phone/Fax

Practice location:
  • Phone: 843-785-2525
  • Fax: 843-785-5394
Mailing address:
  • Phone: 843-785-2525
  • Fax: 843-785-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-507
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS-872
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH DANIEL FARR
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 843-842-2020