Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | LL86421 | SC |
NPI | 1003435504 |
---|---|
Provider Name | Charles Pophal |
First Address | Charleston, SC 29425-8908 |
Second Address | Charleston, SC 29425-1436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2020 |
Last Update Date | 28/06/2021 |