Organization
CAROLINA RETINA CENTER P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY GLENN GROSS M.D. (PRESIDENT)
(803) 736-7200
Entity
Organization
Contact information
Practice address
7620 TRENHOLM ROAD EXT, COLUMBIA, SC 29223-1718
(803) 736-7200
(803) 736-2116
Mailing address
7620 TRENHOLM ROAD EXT, COLUMBIA, SC 29223-1718
(803) 736-7200
(803) 736-2116
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1780
—
SC
Enumeration date
04/25/2006
Last updated
08/04/2017
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