Individual
CHARLES A WILFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
181 W CHEVES ST, FLORENCE, SC 29501-4401
(843) 662-0691
(843) 678-9723
Mailing address
181 W CHEVES ST, FLORENCE, SC 29501-4401
(843) 662-0691
(843) 678-9725
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
790
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D07909
—
SC
Enumeration date
04/26/2006
Last updated
06/02/2017
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