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General NPI Number Information
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NPI Number | 1861540569
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Entity Type | Organization
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Legal Business Name | PALMETTO VISION
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 2110 BELLS HWY
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City | WALTERBORO
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State | SC
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Zip | 29488-6978
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Country | US
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Telephone | 843-559-1992
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Fax | 843-539-1994
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Provider Business Mailing Address
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Address Line | 2245 ASHLEY CROSSING DR UNIT A
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City | CHARLESTON
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State | SC
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Zip | 29414-5704
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Country | US
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Telephone | 843-559-1992
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT P AITKEN
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Credential | OD
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Telephone | 843-539-1992
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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 | 1166
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License Number State | SC
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