Healthcare Provider Details

I. General information

NPI: 1023558996
Provider Name (Legal Business Name): PLANTATION EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FOXBANK PLANTATION BLVD STE A
MONCKS CORNER SC
29461-6725
US

IV. Provider business mailing address

520 PENDLETON DR
MONCKS CORNER SC
29461-8872
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-6485
  • Fax: 843-761-6486
Mailing address:
  • Phone: 843-761-6485
  • Fax: 843-761-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1081
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number717
License Number StateSC

VIII. Authorized Official

Name: KIMBERLY DAWN ROGERS
Title or Position: OWNER
Credential:
Phone: 843-761-6485