Healthcare Provider Details

I. General information

NPI: 1407032295
Provider Name (Legal Business Name): CAROLINA CATARACT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8799 OLD HIGHWAY # 6
SANTEE SC
29142
US

IV. Provider business mailing address

PO BOX 23098
COLUMBIA SC
29224-3098
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-2276
  • Fax: 803-788-1022
Mailing address:
  • Phone: 803-788-2276
  • Fax: 803-788-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN R JACOBS
Title or Position: OWNER
Credential: M.D.
Phone: 803-788-2276