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NPI Code Detail

MEDICARE: DR. JEFFREY P. BLICE M.D.

MEDICARE: DR. JEFFREY P. BLICE M.D.
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
1207W00000XOphthalmology Physician0101223022VA
2207W00000XOphthalmology Physician36080SC
3207WX0107XRetina Specialist (Ophthalmology) Physician36080SC

General Provider Information

NPI Number : 1215930805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY P. BLICE M.D.
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number : 843-792-6200
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8908
Country : US
Telephone Number : 843-792-1414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 04/04/2017

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