MEDICARE: JULIE WASACK OD

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	152W00000X	Optometrist	2536	SC

General Provider Information

NPI Number	:	1225924418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE WASACK OD

Provider Business Mailing Address
First Line	:	392 HORIZON CT
Second Line	:
City	:	HARDEEVILLE
State	:	SC
Zip	:	29927-1615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 FARMFIELD AVE STE C
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7755
Country	:	US
Telephone Number	:	843-763-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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