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NPI Code Detail

MEDICARE: JABE THOMAS PEELE

MEDICARE: JABE THOMAS PEELE
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
1156FX1800XOptician1061SC

General Provider Information

NPI Number : 1851021349
Entity Type Code : Individual
Provider Name (Legal Business Name) : JABE THOMAS PEELE
Provider Business Mailing Address
First Line : 2751 BEAVER RUN BLVD
Second Line :
City : SURFSIDE BEACH
State : SC
Zip : 29575-5381
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2751 BEAVER RUN BLVD
Second Line :
City : SURFSIDE BEACH
State : SC
Zip : 29575-5381
Country : US
Telephone Number : 843-215-3694
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2022
Last Update Date : 06/16/2022

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Directions to “ JABE THOMAS PEELE ” Practice Location

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