MEDICARE: BEAUFORT EYE OPTICAL

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1831962695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT EYE OPTICAL

Provider Business Mailing Address
First Line	:	1664 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1708
Country	:	US
Telephone Number	:	843-522-8466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1708
Country	:	US
Telephone Number	:	843-522-8466
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DEMETRAJANE KOKINAKIS
Credential	:	DO
Telephone Number	:	843-521-7185

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/07/2023

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Directions to “BEAUFORT EYE OPTICAL ” Practice Location

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