NPI | 1063629954 |
---|---|
Other Name | TIDEWATER VISION CENTER |
Entity Type | Organization |
Authorized Contact | FOUAD SAFOU ALLOUCH Owner 843-448-1596 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1211) |
Enumeration Date | 2007-05-17 |
Last Update Date | 2007-08-21 |