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General NPI Number Information
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NPI Number | 1710207741
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Entity Type | Organization
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Legal Business Name | POOLE FAMILY EYE CARE LLC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 1502 W FLOYD BAKER BLVD
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City | GAFFNEY
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State | SC
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Zip | 29341-1271
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Country | US
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Telephone | 864-489-9979
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 W FLOYD BAKER BLVD
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City | GAFFNEY
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State | SC
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Zip | 29341-1271
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Country | US
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Telephone | 864-489-9979
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. EDGAR MORGAN POOLE JR.
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Credential | O.D.
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Telephone | 864-489-9979
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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 | 539
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License Number State | SC
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