Organization
ST. PAUL'S FAMILY EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BOINEAU OPTICIAN (OWNER, OPTICIAN)
(843) 889-9366
Entity
Organization
Contact information
Practice address
7610 HIGHWAY 164, HOLLYWOOD, SC 29449-5934
(843) 889-9366
(843) 889-9133
Mailing address
PO BOX 38, ADAMS RUN, SC 29426-0038
(843) 889-9366
(843) 889-9133
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
730
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DV7305
—
SC
Enumeration date
11/05/2007
Last updated
11/05/2007
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