Provider Demographics
NPI:1316935885
Name:STOKES REGIONAL EYE CENTER
Entity type:Organization
Organization Name:STOKES REGIONAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAKHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-669-4156
Mailing Address - Street 1:PO BOX 100534
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0534
Mailing Address - Country:US
Mailing Address - Phone:843-669-4156
Mailing Address - Fax:843-664-0962
Practice Address - Street 1:115 N MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2309
Practice Address - Country:US
Practice Address - Phone:843-394-2476
Practice Address - Fax:843-394-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0999Medicaid
SC=========002OtherBCBSSC LOCATION ID
SC=========005OtherTRICARE LOCATION ID
SC4601Medicare ID - Type UnspecifiedMEDICARE LOCATION ID