MEDICARE: CAROLINA EYE CLINIC 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	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	T240178001	OTHER	SC	NSC
3	0239370001	OTHER	SC	DME

General Provider Information

NPI Number	:	1477683001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA EYE CLINIC LLC

Provider Business Mailing Address
First Line	:	1901 GADSDEN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2346
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:	803-799-3919

Provider Business Practice Location Address
First Line	:	1901 GADSDEN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2346
Country	:	US
Telephone Number	:	803-799-7358
Fax Number	:	803-799-3919

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	PHILIP DUNNE FLYNN IV
Credential	:
Telephone Number	:	803-799-7358

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	06/03/2026

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Directions to “CAROLINA EYE CLINIC LLC ” Practice Location

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