Provider Demographics
NPI:1861540569
Name:PALMETTO VISION
Entity type:Organization
Organization Name:PALMETTO VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:AITKEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-539-1992
Mailing Address - Street 1:2245 ASHLEY CROSSING DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5704
Mailing Address - Country:US
Mailing Address - Phone:843-559-1992
Mailing Address - Fax:
Practice Address - Street 1:2110 BELLS HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-6978
Practice Address - Country:US
Practice Address - Phone:843-559-1992
Practice Address - Fax:843-539-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9712Medicaid
SCDQ7346OtherRAIL ROAD MEDICARE
SCDQ7346OtherRAIL ROAD MEDICARE
SCDA9712Medicaid