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General NPI Number Information
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NPI Number | 1225084676
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Entity Type | Organization
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Legal Business Name | LTC EYECARE INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 511 PRINCE ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-3627
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Country | US
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Telephone | 843-527-8020
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Fax | 843-546-4111
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Provider Business Mailing Address
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Address Line | PO BOX 481
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City | GEORGETOWN
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State | SC
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Zip | 29442-0481
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Country | US
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Telephone | 843-527-8020
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Fax | 843-546-4111
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Authorized Official
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Title or Position | OWNER
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Name | HARRY OXNER
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Credential |
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Telephone | 843-527-8020
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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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