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General NPI Number Information
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NPI Number | 1134364128
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Entity Type | Organization
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Legal Business Name | PALMETTO EYECARE ASSOCIATES P A
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 2460 INDIA HOOK RD SUITE 206
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City | ROCK HILL
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State | SC
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Zip | 29732-3530
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Country | US
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Telephone | 803-985-2020
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Fax | 803-985-2021
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Provider Business Mailing Address
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Address Line | 2460 INDIA HOOK RD SUITE 206
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City | ROCK HILL
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State | SC
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Zip | 29732-3530
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Country | US
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Telephone | 803-985-2020
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Fax | 803-985-2021
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL BURT
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Credential | O.D.
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Telephone | 803-985-2020
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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 |
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License Number State |
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