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General NPI Number Information
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NPI Number | 1205031234
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Entity Type | Organization
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Legal Business Name | THE RETINA CENTER OF CHARLESTON, PA
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 2057 CHARLIE HALL BLVD SUITE A
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City | CHARLESTON
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State | SC
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Zip | 29414-5834
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Country | US
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Telephone | 843-763-6491
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Fax | 843-763-6371
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Provider Business Mailing Address
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Address Line | 2057 CHARLIE HALL BLVD SUITE A
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City | CHARLESTON
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State | SC
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Zip | 29414-5834
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Country | US
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Telephone | 843-763-6491
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Fax | 843-763-6371
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Authorized Official
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Title or Position | PHYSICIAN,OWNER
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Name | DR. LOWREY PEARSON KING
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Credential | MD
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Telephone | 843-763-6491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 11997
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License Number State | SC
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