Individual
ELYSE DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1470 TOBIAS GADSON BLVD STE 115, CHARLESTON, SC 29407-4835
(843) 556-2020
Mailing address
109 RESIDENCES LN APT 411, CHARLESTON, SC 29414-7995
(619) 890-6902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1998
SC
152WP0200X
Pediatric Optometrist
1998
SC
152WV0400X
Vision Therapy Optometrist
1998
SC
Other
Enumeration date
07/09/2017
Last updated
07/09/2017
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