Organization
FLORENCE PRIMARY EYE CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT BRIAN WALLACE O.D. (PRESIDENT)
(843) 679-9005
Entity
Organization
Contact information
Practice address
2014 S IRBY ST, FLORENCE, SC 29505-3420
(843) 679-9005
Mailing address
1305 MADISON AVE, FLORENCE, SC 29501-4528
(843) 661-5063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1088
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA9755
—
SC
Enumeration date
06/07/2006
Last updated
08/22/2020
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