MEDICARE: CAROLINA FOREST FAMILY EYECARE, P.A.

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	1404	SC

General Provider Information

NPI Number	:	1972621423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FOREST FAMILY EYECARE, P.A.

Provider Business Mailing Address
First Line	:	3874 RENEE DR
Second Line	:	SUITE D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-903-6262
Fax Number	:	843-903-6228

Provider Business Practice Location Address
First Line	:	3874 RENEE DR
Second Line	:	SUITE D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-903-6262
Fax Number	:	843-903-6228

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS WESHEFSKY
Credential	:	O.D.
Telephone Number	:	843-903-0068

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/03/2012

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