MEDICARE: THE VISION CENTER AT SEASIDE FARMS

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	1461	SC

General Provider Information

NPI Number	:	1710111588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VISION CENTER AT SEASIDE FARMS

Provider Business Mailing Address
First Line	:	1296 LONG GROVE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9462
Country	:	US
Telephone Number	:	843-388-6200
Fax Number	:	888-224-4732

Provider Business Practice Location Address
First Line	:	1296 LONG GROVE DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9462
Country	:	US
Telephone Number	:	843-388-6200
Fax Number	:	888-224-4732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID BRADLEY BODKIN
Credential	:	O.D.
Telephone Number	:	843-388-6200

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	08/17/2020

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