Healthcare Provider Details

I. General information

NPI: 1861631343
Provider Name (Legal Business Name): EYE CARE SPECIALTIES GROUP - KIAWAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GARDNERS CIR PMB 159
JOHNS ISLAND SC
29455-5467
US

IV. Provider business mailing address

130 GARDNERS CIR PMB 159
JOHNS ISLAND SC
29455-5467
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL Z MORABITO
Title or Position: MANAGER
Credential: O.D.
Phone: 843-557-2865