Healthcare Provider Details

I. General information

NPI: 1043482722
Provider Name (Legal Business Name): TEGA CAY EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 STONECREST BLVD
TEGA CAY SC
29708
US

IV. Provider business mailing address

600 PINE LINKS DR
TEGA CAY SC
29704-7205
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-4733
  • Fax: 803-802-4735
Mailing address:
  • Phone: 803-802-4733
  • Fax: 803-802-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1468
License Number StateSC

VIII. Authorized Official

Name: LARRY F JERGE
Title or Position: OPTOMETRIST OWNER
Credential: OD
Phone: 803-802-4733