=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275634362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL W BOHAC OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 10/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 MAYBANK HWY
-----------------------------------------------------
City | JOHNS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29455-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-559-5333
-----------------------------------------------------
Fax | 843-559-5339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 874
-----------------------------------------------------
City | JOHNS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29457-0874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-559-5333
-----------------------------------------------------
Fax | 843-559-5339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 907
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------