Healthcare Provider Details

I. General information

NPI: 1841213196
Provider Name (Legal Business Name): SOUTHEASTERN OCULARISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL DR SUITE 260
MT PLEASANT SC
29464-3261
US

IV. Provider business mailing address

8426 MEDICAL PLAZA DR SUITE 500
CHARLOTTE NC
28262-9746
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-7113
  • Fax: 704-510-9881
Mailing address:
  • Phone: 704-510-9292
  • Fax: 704-510-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT HENDERLITE
Title or Position: PRESIDENT
Credential:
Phone: 704-510-9292