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General NPI Number Information
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NPI Number | 1578795902
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Entity Type | Organization
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Legal Business Name | PLAXICO EYE CARE, LLC.
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 749B UNIVERSITY VILLAGE DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7613
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Country | US
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Telephone | 803-714-1116
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Fax | 803-714-1116
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Provider Business Mailing Address
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Address Line | 135I BLYTHEWOOD RD
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8426
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Country | US
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Telephone | 803-714-1116
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Fax | 803-714-1116
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRENT E. PLAXICO
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Credential | O.D.
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Telephone | 803-714-1116
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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 | 1412
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License Number State | SC
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