MEDICARE: CAROLINA EYE AND EAR ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0689474	SC
2	207Y00000X	Otolaryngology Physician	0689474	SC

General Provider Information

NPI Number	:	1114099553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA EYE AND EAR ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2016 SUMTER ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2100
Country	:	US
Telephone Number	:	803-744-2700
Fax Number	:	803-744-7979

Provider Business Practice Location Address
First Line	:	2016 SUMTER ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2100
Country	:	US
Telephone Number	:	803-744-2700
Fax Number	:	803-744-7979

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MAGGIE AGOSTO
Credential	:
Telephone Number	:	803-744-4103

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	04/20/2008

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