Organization
EYES ON THE LAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW DANIELS OD (OWNER/OPTOMETRIST)
(727) 804-3063
Entity
Organization
Contact information
Practice address
2914 DREHER SHOALS RD STE A, COLUMBIA, SC 29212-7909
(803) 575-0723
Mailing address
2914 DREHER SHOALS RD STE A, COLUMBIA, SC 29212-7909
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1597
SC
Other
Enumeration date
04/02/2018
Last updated
07/27/2023
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