=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083846596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARWOOD EYE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2009
-----------------------------------------------------
Last Update Date | 04/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1009 BELLS HWY
-----------------------------------------------------
City | WALTERBORO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29488-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-549-8511
-----------------------------------------------------
Fax | 843-549-1892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 CULVER AVE
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-6284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-229-2019
-----------------------------------------------------
Fax | 888-529-0481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | KIRSTEN HARWOOD
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 248-229-2019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1558
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------