| NPI | 1073688602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY WATKINS DAVENPORT Manager 843-722-4416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 509) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: SC 152) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 509) | |
| 156FX1800X Technician/Technologist, Optician (Licence: SC 501) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-07-16 |