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General NPI Number Information
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NPI Number | 1467594408
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Entity Type | Organization
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Legal Business Name | SKUFCA ENTERPRISES LLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 615 LAURENS ST
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City | CAMDEN
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State | SC
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Zip | 29020
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Country | US
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Telephone | 803-432-6765
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Fax | 803-432-8441
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Provider Business Mailing Address
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Address Line | 615 LAURENS ST
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City | CAMDEN
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State | SC
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Zip | 29020
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Country | US
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Telephone | 803-432-6765
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Fax | 803-432-8441
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL W SKUFCA
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Credential | MD
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Telephone | 803-432-9874
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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 | 596
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 26982
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License Number State | SC
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