Provider Demographics
NPI:1114280526
Name:PALMETTO CATARACT AND EYE SPECIALISTS, LLC
Entity type:Organization
Organization Name:PALMETTO CATARACT AND EYE SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ITHARAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-259-2002
Mailing Address - Street 1:515 CARNES CROSSING BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-0412
Mailing Address - Country:US
Mailing Address - Phone:843-259-2002
Mailing Address - Fax:
Practice Address - Street 1:515 CARNES CROSSING BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486
Practice Address - Country:US
Practice Address - Phone:843-259-2002
Practice Address - Fax:843-259-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC31320OtherSTATE LICENSE
SC31320OtherSTATE LICENSE
SC31320OtherSTATE LICENSE