Provider Demographics
NPI:1306116256
Name:ATLANTIC EYE ASSOCIATES
Entity type:Organization
Organization Name:ATLANTIC EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-651-8200
Mailing Address - Street 1:3911A HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5014
Mailing Address - Country:US
Mailing Address - Phone:843-651-8200
Mailing Address - Fax:843-651-8236
Practice Address - Street 1:8028 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-347-7236
Practice Address - Fax:843-347-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC46720Medicare UPIN
SCC467207536Medicare PIN