Healthcare Provider Details

I. General information

NPI: 1629220611
Provider Name (Legal Business Name): CATARACT AND LASER CENTER OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 HIGHWAY 78 SUITE 100
LADSON SC
29456-4118
US

IV. Provider business mailing address

9565 HIGHWAY 78 SUITE 100
LADSON SC
29456-4118
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-2477
  • Fax: 843-553-2478
Mailing address:
  • Phone: 843-553-2477
  • Fax: 843-553-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28648
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN EDWARD THOMPSON III
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 843-553-2477