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General NPI Number Information
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NPI Number | 1356668032
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Entity Type | Organization
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Legal Business Name | COVINGTON OPTOMETRIC EYE CLINIC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 703 MARKET ST
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City | CHERAW
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State | SC
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Zip | 29520-2658
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Country | US
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Telephone | 843-537-3641
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Fax | 843-537-3646
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Provider Business Mailing Address
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Address Line | 703 MARKET ST
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City | CHERAW
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State | SC
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Zip | 29520-2658
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Country | US
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Telephone | 843-537-3641
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Fax | 843-537-3646
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Authorized Official
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Title or Position | PRACTICE CONSULTANT
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Name | ABBIE C PREVATT
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Credential |
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Telephone | 843-537-3641
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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 | 1588
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License Number State | SC
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