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Organization
CAROLINA GLAUCOMA AND VISION CENTER
Active
Organization
CAROLINA GLAUCOMA AND VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALRIC CHRISTOPHER BLAKE M.D. (OWNER)
(803) 779-4144
Entity
Organization
Contact information
Practice address
1 RICHLAND MEDICAL PARK DR, SUITE 210, COLUMBIA, SC 29203-6834
(803) 789-4144
(803) 779-4146
Mailing address
1 RICHLAND MEDICAL PARK DR, SUITE 210, COLUMBIA, SC 29203-6834
(803) 789-4144
(803) 779-4146
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
17330
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180026568
RAILROAD MEDICARE
SC
05
—
GP1498
—
SC
Enumeration date
01/25/2007
Last updated
09/09/2009
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