| NPI | 1487631867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM FAULKNER Administrator 843-577-2047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-05-02 |