# CAROLINA GLAUCOMA AND VISION CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700931979
- **Authorized official:** DR. ALRIC CHRISTOPHER BLAKE M.D. (OWNER)
- **Authorized official phone:** (803) 779-4144

## Contact information

- **Practice address:** 1 RICHLAND MEDICAL PARK DR, SUITE 210, COLUMBIA, SC 29203-6834
- **Practice address phone:** (803) 789-4144
- **Practice address fax:** (803) 779-4146
- **Mailing address:** 1 RICHLAND MEDICAL PARK DR, SUITE 210, COLUMBIA, SC 29203-6834
- **Mailing address phone:** (803) 789-4144
- **Mailing address fax:** (803) 779-4146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 17330 | SC | Yes |

## Other

- **Enumeration date:** 01/25/2007
- **Last updated:** 09/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180026568 | RAILROAD MEDICARE | SC |
| 05 | — | GP1498 | — | SC |