Healthcare Provider Details

I. General information

NPI: 1669037974
Provider Name (Legal Business Name): MEYE VISION CARE AND EYEWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 FRESHFIELDS DRIVE
JOHNS ISLAND SC
29455
US

IV. Provider business mailing address

634 FRESHFIELDS DRIVE
JOHNS ISLAND SC
29455
US

V. Phone/Fax

Practice location:
  • Phone: 843-768-0565
  • Fax: 843-768-0566
Mailing address:
  • Phone: 843-768-0565
  • Fax: 843-768-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEREK SCOTT MAROUN
Title or Position: OWNER/PHYSICIAN
Credential: OD
Phone: 843-768-0565