| NPI | 1174726210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET KELLY BESSINGER Admin Assist 843-556-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 503) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1413) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 503) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 1413) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: SC 1413) | |
| 152WS0006X Optometrist, Sports Vision (Licence: SC 503) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: SC 503) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2015-11-12 |