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Contact Information

JACKSON DAVENPORT INC.
379 KING ST
CHARLESTON, SC29401-1438
 Phone: 843-722-4416
 Fax: 843-720-8984
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Contact Lens Fitter

156FC0801X
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Optician

156FX1800X 96[5] Optician
Indicates primary specialty

NPI Profile & details for JACKSON DAVENPORT INC · (Female)

NPI # 1073688602
Status Active
Credentials
Entity Individual
Enumeration date 11/21/2006
Last updated 07/16/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • SC License # 152
  • SC License # 501
  • SC License # 509
  • SC Medicaid DA9859
  • SC Other 62167 FIRST CHOICE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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