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General NPI Number Information
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NPI Number | 1568642783
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Entity Type | Organization
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Legal Business Name | ST. PAUL'S FAMILY EYE CARE
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 7610 HIGHWAY 164
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City | HOLLYWOOD
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State | SC
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Zip | 29449-5934
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Country | US
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Telephone | 843-889-9366
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Fax | 843-889-9133
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | ADAMS RUN
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State | SC
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Zip | 29426-0038
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Country | US
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Telephone | 843-889-9366
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Fax | 843-889-9133
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Authorized Official
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Title or Position | OWNER, OPTICIAN
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Name | SUSAN BOINEAU
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Credential | OPTICIAN
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Telephone | 843-889-9366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 730
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License Number State | SC
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