Provider Demographics
NPI:1043971112
Name:GRAND STRAND RETINA PC
Entity type:Organization
Organization Name:GRAND STRAND RETINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-420-7106
Mailing Address - Street 1:14361 OCEAN HWY UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4806
Mailing Address - Country:US
Mailing Address - Phone:518-420-7106
Mailing Address - Fax:
Practice Address - Street 1:14361 OCEAN HWY UNIT 2B
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4806
Practice Address - Country:US
Practice Address - Phone:518-420-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery