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General NPI Number Information
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NPI Number | 1497869945
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Entity Type | Individual
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Provider Name | ALICE C SUN O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1231 FOLLY RD
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City | CHARLESTON
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State | SC
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Zip | 29412-4105
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Country | US
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Telephone | 873-795-3400
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Fax | 843-795-3435
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Provider Business Mailing Address
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Address Line | 1231 FOLLY RD
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City | CHARLESTON
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State | SC
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Zip | 29412-4105
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Country | US
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Telephone | 873-795-3400
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Fax | 843-795-3435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1111
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1111
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License Number State | SC
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