Healthcare Provider Details

I. General information

NPI: 1851681290
Provider Name (Legal Business Name): CAROLINA EYECARE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MIDLAND PKWY
SUMMERVILLE SC
29485-8101
US

IV. Provider business mailing address

2861 TRICOM ST
N CHARLESTON SC
29406-9172
US

V. Phone/Fax

Practice location:
  • Phone: 843-873-5577
  • Fax:
Mailing address:
  • Phone: 843-863-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DANIEL G FLYNN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 843-725-0064