MEDICARE: PREFERRED EYECARE CENTER, 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	1473	SC

General Provider Information

NPI Number	:	1598924151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED EYECARE CENTER, LLC

Provider Business Mailing Address
First Line	:	1054 ANNA KNAPP BLVD APT 12F
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3168
Country	:	US
Telephone Number	:	843-822-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 PARK WEST BLVD
Second Line	:	SUITE 5
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-7124
Country	:	US
Telephone Number	:	843-856-4775
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. RACHAEL CATHLEEN CLICK
Credential	:	O.D.
Telephone Number	:	843-856-4775

Provider Enumeration Date	:	06/08/2008
Last Update Date	:	05/08/2012

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