| NPI | 1972756682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD ANDERSON Manager/O PT Ician 843-572-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: SC SC0551) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: SC 1997-03227) |
| Enumeration Date | 2008-10-25 |
| Last Update Date | 2008-10-25 |