Basic Information
| Provider Information | |||||||||
| NPI: | 1336137751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STOKES REGIONAL EYE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100534 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295010534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436694156 | ||||||||
| FaxNumber: | 8436640962 | ||||||||
| Practice Location | |||||||||
| Address1: | 3032 E HIGHWAY 76 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434647097 | ||||||||
| FaxNumber: | 8434649667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZAKHOUR | ||||||||
| AuthorizedOfficialFirstName: | ISAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8436694156 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | GP2643 | 05 | SC | MEDICAID |