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Organization
PALMETTO RETINA CENTER LLC
Active
Organization
PALMETTO RETINA CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A WELLS III MD (MANAGING MEMBER)
(803) 931-0077
Entity
Organization
Contact information
Practice address
124 SUNSET COURT, WEST COLUMBIA, SC 29169
(803) 931-0077
(803) 931-0076
Mailing address
124 SUNSET COURT, WEST COLUMBIA, SC 29169
(803) 931-0077
(803) 931-0076
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0623
—
SC
Enumeration date
11/02/2005
Last updated
12/09/2020
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