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General NPI Number Information
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NPI Number | 1063629954
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Entity Type | Organization
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Legal Business Name | ALLOUCH OPTOMETRY
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 1175 N FRASER ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-2851
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Country | US
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Telephone | 843-527-2682
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Fax | 843-527-2721
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Provider Business Mailing Address
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Address Line | 2703 N KINGS HWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-3011
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Country | US
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Telephone | 843-448-1596
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Fax | 843-448-4793
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Authorized Official
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Title or Position | OWNER
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Name | DR. FOUAD SAFOU ALLOUCH
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Credential | O.D.
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Telephone | 843-448-1596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1211
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License Number State | SC
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