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General NPI Number Information
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NPI Number | 1114908092
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Entity Type | Organization
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Legal Business Name | GOOSE CREEK VISION CENTER, INC.
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 425 REDBANK RD
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City | GOOSE CREEK
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State | SC
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Zip | 29445-4505
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Country | US
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Telephone | 843-797-1264
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Fax | 843-764-3602
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Provider Business Mailing Address
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Address Line | 425 REDBANK RD
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City | GOOSE CREEK
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State | SC
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Zip | 29445-4505
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Country | US
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Telephone | 843-797-1264
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Fax | 843-764-3602
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MELVIN B. WATSKY
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Credential | O.D.
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Telephone | 843-797-1264
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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 | SC568
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License Number State | SC
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