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General NPI Number Information
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NPI Number | 1508143173
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Entity Type | Organization
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Legal Business Name | J TAYLOR PRCHAL INC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 4900 CENTRE POINTE DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-6927
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Country | US
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Telephone | 843-554-2223
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Fax | 843-529-9724
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Provider Business Mailing Address
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Address Line | 130 RIVER LANDING DR #3316
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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 | 540-239-5324
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Fax | 843-529-9724
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH TAYLOR PRCHAL
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Credential | OD
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Telephone | 540-239-5324
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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 | 1601
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License Number State | SC
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