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General NPI Number Information
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NPI Number | 1942267968
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Entity Type | Individual
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Provider Name | CHARLES A WILFONG OD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/02/2017
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Provider Practice Location Address
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Address Line | 181 W CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29501-4401
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Country | US
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Telephone | 843-662-0691
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Fax | 843-678-9723
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Provider Business Mailing Address
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Address Line | 181 W CHEVES ST
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City | FLORENCE
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State | SC
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Zip | 29501-4401
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Country | US
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Telephone | 843-662-0691
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Fax | 843-678-9725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 790
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License Number State | SC
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