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General NPI Number Information
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NPI Number | 1275867061
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Entity Type | Organization
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Legal Business Name | CATHERINE E. KISTER, O.D. LLC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 1112 N MAIN ST STE E
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7315
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Country | US
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Telephone | 843-261-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 130 RIVER LANDING DR 2202
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City | DANIEL ISLAND
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State | SC
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Zip | 29492-7400
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Country | US
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Telephone | 843-822-0466
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. CATHERINE EMILY KISTER
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Credential | O.D.
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Telephone | 843-822-0466
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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 | 1417
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License Number State | SC
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