Healthcare Provider Details

I. General information

NPI: 1407066905
Provider Name (Legal Business Name): OPTICAL IMPRESSIONS, A LIMITED LIABILITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8096 RIVERS AVE STE A
NORTH CHARLESTON SC
29406-9243
US

IV. Provider business mailing address

8096 RIVERS AVE STE A
NORTH CHARLESTON SC
29406-9243
US

V. Phone/Fax

Practice location:
  • Phone: 843-818-2020
  • Fax:
Mailing address:
  • Phone: 843-818-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LAWRENCE EDWIN RICHARD
Title or Position: PRESIDENT
Credential:
Phone: 843-818-2020