MEDICARE: POOLE EYECARE PA

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	SC728	SC

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

General Provider Information

NPI Number	:	1699733501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOLE EYECARE PA

Provider Business Mailing Address
First Line	:	121 BETHEL ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1101
Country	:	US
Telephone Number	:	803-222-9538
Fax Number	:	803-222-1898

Provider Business Practice Location Address
First Line	:	121 BETHEL ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1101
Country	:	US
Telephone Number	:	803-222-9538
Fax Number	:	803-222-1898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENJAMIN C POOLE
Credential	:	OD
Telephone Number	:	803-222-9538

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/14/2024

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Directions to “POOLE EYECARE PA ” Practice Location

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