Healthcare Provider Details

I. General information

NPI: 1275608499
Provider Name (Legal Business Name): NORRIS RICK PHILBECK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9270 N HIGHWAY 17
MC CLELLANVILLE SC
29458-9422
US

IV. Provider business mailing address

1544 OLDENBURG DR 303
MOUNT PLEASANT SC
29429-4966
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-4416
  • Fax: 843-720-8984
Mailing address:
  • Phone: 843-722-4416
  • Fax: 843-720-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number509
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: