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General NPI Number Information
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NPI Number | 1275580805
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Entity Type | Organization
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Legal Business Name | PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 340 W BUTLER ST
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City | LEXINGTON
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State | SC
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Zip | 29072-2606
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Country | US
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Telephone | 803-359-8777
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Fax | 803-359-1513
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Provider Business Mailing Address
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Address Line | 340 W BUTLER ST
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City | LEXINGTON
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State | SC
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Zip | 29072-2606
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Country | US
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Telephone | 803-359-8777
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Fax | 803-359-1513
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARK SANFORD KEISLER
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Credential | MD
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Telephone | 803-359-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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