Provider Demographics
NPI:1992985071
Name:PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:KEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-359-8777
Mailing Address - Street 1:121 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8016
Mailing Address - Country:US
Mailing Address - Phone:803-532-3023
Mailing Address - Fax:803-532-3386
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8016
Practice Address - Country:US
Practice Address - Phone:803-532-3203
Practice Address - Fax:803-532-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0449570002Medicare NSC
SC6086Medicare PIN