Organization
DISTINCTIVE EYEWEAR VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURI BALDWIN GRAHAM O.D. (OWNER)
(843) 213-1201
Entity
Organization
Contact information
Practice address
1206 MOSER DR, THE MARKET COMMON, MYRTLE BEACH, SC 29577-1575
(843) 213-1201
Mailing address
1206 MOSER DR, THE MARKET COMMON, MYRTLE BEACH, SC 29577-1575
(843) 213-1201
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1396
SC
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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