Provider Demographics
NPI:1497869945
Name:SUN, ALICE C (OD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:SUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4105
Mailing Address - Country:US
Mailing Address - Phone:873-795-3400
Mailing Address - Fax:843-795-3435
Practice Address - Street 1:1231 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4105
Practice Address - Country:US
Practice Address - Phone:873-795-3400
Practice Address - Fax:843-795-3435
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1111152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10403OtherSPECTERA
SC47104OtherDAVIS VISION
SCD6995OtherMEDCOST
SC571077813OtherSUPERIOR VISION
SC571077813OtherTHOMAS COOPER
SCD11111Medicaid
SC571077813OtherBCBS
SC571077813OtherBCBS