MEDICARE: DR. ALICE C SUN O.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
1	152W00000X	Optometrist	1111	SC
2	152WC0802X	Corneal and Contact Management Optometrist	1111	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10403	OTHER	SC	SPECTERA
2	47104	OTHER	SC	DAVIS VISION
3	D6995	OTHER	SC	MEDCOST
4	571077813	OTHER	SC	SUPERIOR VISION
5	571077813	OTHER	SC	THOMAS COOPER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	571077813	OTHER	SC	BCBS

General Provider Information

NPI Number	:	1497869945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE C SUN O.D.

Provider Business Mailing Address
First Line	:	1231 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4105
Country	:	US
Telephone Number	:	873-795-3400
Fax Number	:	843-795-3435

Provider Business Practice Location Address
First Line	:	1231 FOLLY RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4105
Country	:	US
Telephone Number	:	873-795-3400
Fax Number	:	843-795-3435

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/04/2007

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