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General NPI Number Information
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NPI Number | 1699182436
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Entity Type | Organization
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Legal Business Name | MIDLANDS EYE ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 470 TOWN CENTER PL STE 5
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City | COLUMBIA
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State | SC
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Zip | 29229-7957
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Country | US
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Telephone | 843-424-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 268 SHOREWARD DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-5146
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Country | US
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Telephone | 843-424-2553
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Fax |
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Authorized Official
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Title or Position | MANAGING OPTOMETRIST
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Name | DR. LAWRENCE RAYMOND CUSTER
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Credential | O.D.
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Telephone | 843-424-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 1237
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License Number State | SC
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