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General NPI Number Information
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NPI Number | 1689831521
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Entity Type | Organization
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Legal Business Name | PALMETTO EYE SPECIALISTS-OPTOMETRISTS
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 220 PEMBROKE DR
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City | HILTON HEAD
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State | SC
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Zip | 29926-6200
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Country | US
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Telephone | 843-785-5398
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Fax | 843-785-5394
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Provider Business Mailing Address
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Address Line | 220 PEMBROKE DR
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City | HILTON HEAD
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State | SC
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Zip | 29926-6200
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Country | US
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Telephone | 843-785-5398
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Fax | 843-785-5394
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | EMILY C BOLLIN
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Credential | OD
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Telephone | 843-785-5398
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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 | 1462
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License Number State | SC
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