Provider Demographics
NPI:1447870688
Name:CAROLINA SPECIALTY EYE SURGERY, LLC
Entity type:Organization
Organization Name:CAROLINA SPECIALTY EYE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:FOX
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BSN, RN
Authorized Official - Phone:864-583-6381
Mailing Address - Street 1:1530 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5121
Mailing Address - Country:US
Mailing Address - Phone:864-583-6381
Mailing Address - Fax:
Practice Address - Street 1:1530 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5121
Practice Address - Country:US
Practice Address - Phone:864-583-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery