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General NPI Number Information
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NPI Number | 1386002467
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Entity Type | Organization
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Legal Business Name | BERGELT OPTOMETRIC LLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 2672 DAVID MCLEOD BLVD
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City | FLORENCE
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State | SC
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Zip | 29501
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Country | US
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Telephone | 803-760-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 BRENTWOOD CT
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City | COLUMBIA
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State | SC
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Zip | 29206-2871
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Country | US
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Telephone | 910-736-9833
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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 | SOLITA JONES BERGELT
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Credential | O.D.
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Telephone | 910-736-9833
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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 | 1835
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License Number State | SC
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