MEDICARE: ATLANTIC EYE ASSOCIATES

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	:	1982721270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	3911 HIGHWAY 17
Second Line	:	SUITE A
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5014
Country	:	US
Telephone Number	:	843-651-8200
Fax Number	:	843-651-8236

Provider Business Practice Location Address
First Line	:	3911 HIGHWAY 17
Second Line	:	SUITE A
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5014
Country	:	US
Telephone Number	:	843-651-8200
Fax Number	:	843-651-8236

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN J PLY
Credential	:	M.D.
Telephone Number	:	843-651-8200

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	12/21/2011

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