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General NPI Number Information
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NPI Number | 1548710155
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Entity Type | Organization
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Legal Business Name | PALMETTO OCULOPLASTICS
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 613 LONG POINT RD SUITE 201
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City | MT PLEASANT
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State | SC
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Zip | 29464-8350
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Country | US
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Telephone | 478-845-3515
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Fax | 478-845-3516
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Provider Business Mailing Address
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Address Line | 211 MAIN ST
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City | BARNESVILLE
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State | GA
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Zip | 30204-1469
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Country | US
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Telephone | 478-845-3515
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Fax | 478-845-3516
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Authorized Official
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Title or Position | OWNER
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Name | BYRON DEEN
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Credential | MD
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Telephone | 478-845-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD31662
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License Number State | SC
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