Robert J Black, OD | |
171 Ashley Ave, Charleston, SC 29425-0001 | |
(843) 792-1414 | |
Not Available |
Full Name | Robert J Black |
---|---|
Gender | Male |
Speciality | Optometrist |
Location | 171 Ashley Ave, Charleston, South Carolina |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003828534 | NPI | - | NPPES |
D12010 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1201 (South Carolina) | Primary |
Provider Name | University Medical Associates |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1043241110 PECOS PAC ID: 6305758574 Enrollment ID: O20031105000291 |
Mailing Address | Practice Location Address |
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Robert J Black, OD Po Box 751461, Charlotte, NC 28275-1461 Ph: (843) 792-6200 | Robert J Black, OD 171 Ashley Ave, Charleston, SC 29425-0001 Ph: (843) 792-1414 |
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