Provider Demographics
NPI:1518955087
Name:STOKES REGIONAL EYE CENTER
Entity type:Organization
Organization Name:STOKES REGIONAL EYE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-669-4156
Mailing Address - Street 1:367 W EVANS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3429
Mailing Address - Country:US
Mailing Address - Phone:843-669-4156
Mailing Address - Fax:843-664-2121
Practice Address - Street 1:365 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1987
Practice Address - Country:US
Practice Address - Phone:803-905-8020
Practice Address - Fax:803-905-8025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOKES REGIONAL EYE CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-10
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCG2815OtherRAILROAD MEDICARE
SCGP2698Medicaid
SC=========006OtherBCBSSC LOCATION ID
SCGP2698Medicaid
SC=========006OtherTRICARE LOCATION ID